Project Request Form

Please answer the questions below, tick the appropriate option and provide the requested information.

1. Company Data

Company Name *

Field of Activity

Address

Contact Person *

Phone *

E-mail *

2. Production Data

What is production capacity by product?

Product Name	Capacity (ton/month, nr/month...)

What are the chemicals, raw materials used for production?

Chemical / Raw Material	Capacity (ton/month, nr/month...)

3. Wastewater Characteristics and Flow

Request regarding the treatment plant:

New wastewater treatment plant Revision of existing plant Expansion of existing plant Water reuse

What is the wastewater sources and flow by process? (m3/day)

Are wastewater sources separate or combined?

Combined Separate

What is the flow characteristic?

Continuous (24h) Batch:

What are the CURRENT characteristics of wastewater?

COD:

TSS:

PH:

Oil & Grease:

Nitrogen:

Phosphorus:

Sulfate:

Sulphide:

Iron:

Cr+6:

Cr+3:

Cyanide:

What is the REQUIRED water quality for treated wastewater?

COD:

TSS:

PH:

Oil & Grease:

Nitrogen:

Phosphorus:

Sulfate:

Sulphide:

Iron:

Cr+6:

Cr+3:

Cyanide:

Temperature of wastewater (°C)

Commissioning Period (months)

4. Attachments

Please send the information and reports you want to add: Max file size: 10MB. Allowed types: PDF, Word, Excel, ZIP, Image.

Date

Name / Signature (Type your full name)