days per week
| Company Name: | _____________________________________________________ |
| Person to Contact: | _____________________________________________________ |
| Title: | _____________________________________________________ |
| Address: | _____________________________________________________ |
| City: ____________________ State: ___ Zip Code: _______ | |
| Phone: | (____)______________________ |
| Fax: | (____)______________________ |
| How did you hear about Metre-General, Inc.: | ___________________________________ |
| What is the source of the waste stream to be treated: | |
| What is the average flow rate: | GPM |
| What are the hours of operation: | per day days per week |
| What is the pH of the waste stream to be treated: | pH |
| What heavy metals are present: | Their average concentrations (ppm): | Their Allowable Limits (ppm): |
| What organic compounds are present: | |
| What are their qualities and characteristics: | |
| What is the current waste water treatment system: | |
| What chemicals are used: | |
| How much space is available for a waste water treatment system: | _____ ft by _____ ft |
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