Delta Packaged Wastewater Treatment Plants - Referral Form
* Required Field
Sales Referral Source
*
Date of Referral
*
RFQ Number
Distributor Name
Phone
1
Main sales contact requesting a submittal and quotation for a package wastewater treatment plant.
Contact Name
*
Title
Address 1
*
Address 2
Address 3
City
*
State
*
Choose One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Canada
Zip
*
Email
*
Phone
*
Fax
2
Information on package wastewater treatment plant (required for quotation)
Project Name
*
Plant Type:
Domestic
Industrial
Address 1
*
Address 2
Address 3
City
State
Choose One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Canada
Zip
Engineering Firm
*
Engineer's Name
Address 1
Address 2
Address 3
City
State
Choose One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Canada
Zip
Due date for submittal and quote
*
Number of submittal copies required
*
3
Hydraulic Conditions
Hydraulic Load (Design)
*
GPD
Inflow Period
*
Hours/Day
Peak Daily Flow
*
Peak Hourly Flow
*
GPD
4
Influent Parameters (mg/l)
BOD5
*
TSS
*
COD
NH3
pH
Phosphorus
FOG
5
Effluent Requirements (Permit)
BOD5 (winter)
*
BOD5 (summer)
*
TSS (winter)
*
TSS (summer)
*
NH3 (winter)
*
NH3 (summer)
*
Fecal/Coliform
*
TN
*
Phosphorus
*
D.O.
*
6
Power Available
Volts
Phase
Hz
Electrical Requirements
7
Desired Equipment
Check all that apply
Flow Equalization
Sludge Holding
Cholrination
Ultravoilet Disinfection
Comminutor
Decholrination
Teriary Treatment
Flow Measurement
8
Site Criteria
Type of Application (subdivisions, school, factory)
*
Location
Above Ground
Below Ground
Elevation
Below 5000 ft.
Above 5000 ft.
Type of Construction
Coated Steel
Stainless Steel
Concrete
Coating
Standard Coal Tar Epoxy
Special
Sand Blasting
Standard SPC6
Standard SPC10 - Near White
Constraints or Conditions
Name of Other companies competing for the project
Notes
Please only click Submit button once.
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