LifeSource Engineering

Client:

Date:

Address:

Address 2:

City, State, Zip:

Country:

Phone:

Fax:

Email:

I prefer to be contacted by:

Phone

Fax

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The information and data requested by this form is essential to properly size and apply LifeSource Engineering, Inc. recommended systems. Each system is custom engineered for a given application and water supply. This insures proper feedwater pretreatment and that the system is designed for maximum performance at minimum cost. Submit this data from the installation site and the results of the Silt Density Index (SDI) Test for a complete Reverse Osmosis, Ultrafiltration or Membrane Softening water treatment system quotation. The SDI Test is a critical factor in determining to what extent pretreatment equipment might be required.

Is this inquiry for a study, budget quote, or for a firm project?

Who will purchase, own and operate the plant?

Required water usage per day:

What storage capacity is available?

Laboratory analysis of raw feed water completed?

Yes

No

Self-analysis (by client) of raw feed water attached?

Yes

No

Feed water supply:

Well Surface

Open Sea

Well-Artesian

Pressure (psig)(kPa)

Is there a history of seasonal fluctuations?

Yes

No

If yes, describe:

Feed water pH at site:

Maximum Total Dissolved Solids (TDS):

Temperature range of feed water:
Minimum Maximum Average

Time schedule for project:
Start date: Completion Date:

Power (available for water production):
Volt Phases Hertz Amps

Cost per KW:
Average rate Peak rate Off peak rate

Is this installation to be made in an existing equipment room?

Yes

No

If so, give dimensions of existing space and entryways.

What will the product be used for?