Waste Water Questionnaire

Name: Company
Address: City:
State/Province: Postal/Zip:
Phone: Email:
Date    

1. Waste Water Flow
Average Flow: lph gph
Peak Flow: lph gph
Hours/Days of Operation:    
Total Daily Waste Water:    

2. Waste Water Description
a. Industry

b. Origin of Flow
(i.e., source of waste water
such as plant effluent)

c. TSS
(Total Suspended Solids)
Normal
Maximum % ppm
Size Range mm Microns
Specific Gravity

d. Temperature, Normal Maximum Deg. F Deg. C

e. Ph, Normal

f. BOD, Normal Maximum ppm

g. COD, Normal Maximum ppm

h. Hydrocarbon type Volume

i. Fat, Grease, Oil Content
(Food Industry), Normal
Maximum ppm

3. Discharge Objectives
Hydrocarbons ppm
TSS (Total Suspended Solids) ppm
COD ppm BOD ppm

4. Project Schedule
1 month 3 months 6 months 1 year Future Budget

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