Lift Station Diagnostic Form

Your name:
Your E-mail address:
Phone:
Fax:
Company Name:
Address:
Distributor:

Capacity of Lift Station (# of gallons)

Dimensions

Daily influent ( if known)

Influent pH

Effluent pH

Alkalinity

BOD5 in mg/l

COD in mg/l

Hydrogen sulfide odor present? YESNO Has hydrogen sulfide been detected by test? YESNO

How thick is the grease cap?

Ammonia

Any problem with copper, lead, mercury? YESNO

Is this typical food waste? YESNO If waste is unusual, check any of the items listed below or add your own comment: More pastries than usual More bacon and other fat Extra cleaning compounds used Other

How often are disinfectants used? Do the disinfectants empty directly to this station? YESNO

Other than meeting discharge regulations, are there any other treatment goals? Goal of odor control Goal of clearing clogged pipes goal of eliminating corrosion to pipes and lift station Other goals

Discharge Permit information:

 

Questions About Current Product and How Applied

What sort of pump is used to apply current product?

Where does pump deliver dosage of product? (Select one or more that apply) Under surface Over surface In one corner of the lift station

How often is pump set to deliver product dosage? (Check one) every 15 minutes hourly daily twice a week Describe any other adjustments possible:

Name of the current product being used ? Why are you dissatisfied with current product?

Did you use any other products before current product? YES NO How did you compare with your current product?

We usually add all people who inquire about our products to our newsletter mailing list, which is kept for in-house use. We do not ever sell or trade names of our clients, and rarely contact by e-mail more than once a month. Mailing list: YES NO

 

for the old "print and fax" version of this form

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