Facility Name:


Your Name: *


Your Title:


Email Address: *


Address (Line 1): *


Address (Line 2):


City: *


State/Province: *


Zip/Post: *


Country: *


Telephone: *


Fax:


Facility Type: *


Plant Name:


Is algae present?
Yes
No

Are odors present?
Yes
No

Are bottom solids present?
Yes
No

Is water clarity an issue?
Yes
No

Other water quality issues? Please list:


Describe problem areas:


How many lakes or ponds on property:


How many with water quality problems:


Source of water:
Please Select City Runoff Effluent Stream/River Well Other

If "other," please list:


pH of water requiring treatment:


Dissolved Oxygen (DO) content:


Temperature of water:


Depth of bottom solids (if applicable):


Total volume in gallons or dimensions of pond:


Is there an operating aeration system?
Yes
No

Do you lose (stream, overflow) more than 40% of the pond's total volume in a single day?
Yes
No

Has algae already begun to grow?
Yes
No

If yes, please detail the extent of the algae problem:


NO3:


NO2:


NH3:


NH4:


Total Phosphorus:


Hardness:


Alkalinity:


Type of filtration (if used):


Type of sterilization (if used):


Chemicals used (if applicable):


Fish Stocking Density (if applicable):


Please disregard this field. It is for tracking purposes.
Survey - Pond Treatment