Project Application Questionnaire
NOTE: Thank you for considering us for your water treatment needs. So that our experts can offer the most accurate and competitive proposal, please complete as many of the questions as you are able.
Hawkins Sales Representative:
Please Select
Chip Nolan
Corey Harper
Dan Stroud
Dave Harvey
Doug Lange
Dustin Danker
Eric Sorenson
Jack Singleton
Kris Staff
Lance Roach
Mark Weirich
Max Walker
Michael Sapienza
Russ Teders
Steve Kokesh
Tim Donovan
Tom Tedrick
Other or Unknown
Project Name:
Provide a general description of the application
Customer Contact:
Municipality or Customer:
Phone Number:
Format: (000) 000-0000.
Email Address:
Site Location:
Street Address
City
State / Province
Postal / Zip Code
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Project Information
Contaminants To Be Addressed:
Iron (Fe)
Radium (Ra)
Manganese (Mn)
Arsenic (As)
Nitrates (NO3)
PFAS (Synthetic Chemicals)
Other
Other Contaminants To Be Addressed:
What is the source of the feedwater?
Well or Ground Water (Untreated)
Surface Water
Municipal Potable Water (Treated)
Other
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Is current water chemistry data available?
Yes, Upload Water Testing Report Files
Yes, Manually Enter Water Data
No
Incoming Water Quality
Please contact your Hawkins Representative to conduct water sampling and testing.
Upload Feed Water Quality Reports For All Water Sources:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Required Water Quality:
Rows
Source 1
Source 2
Source 3
Source 4
Source or Well Name
Street Address
Feed Flowrate [GPM]
Feed Pressure [PSI]
Water Temperature [°F]
Daily Hours Online
Hardness (as CaCO3) [PPM]
pH
Iron (as Fe) [PPM]
Manganese (as Mn) [PPB]
TDS [PPM]
Sulfate (as SO4) [PPM]
Alkalinity (as CaCO3) [PPM]
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Preferred Water Quality:
Rows
Source 1
Source 2
Source 3
Source 4
Source or Well Name
Ammonia (as NH3) [PPM]
Arsenic (as As) [PPM]
Magnesium (as Mg) [PPM]
Sodium (as Na) [PPM]
Radium (as Ra) [PPM]
Chloride (as Cl) [PPM]
Phosphate (as PO4) [PPM]
Nitrate (as NO3) [PPM]
Nitrite (as NO2) [PPM]
Fluoride (as F) [PPM]
Silica (as SiO2) [PPM]
TSS [PPM]
TOC [PPM]
Hydrogen Sulfide (as H2S) [PPM]
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Optional Water Quality:
Rows
Source 1
Source 2
Source 3
Source 4
Source or Well Name
Barium (as Ba) [PPM]
Zinc (as Zn) [PPM]
Boron (as B) [PPM]
Strontium (as Sr) [PPM]
Potassium (as K) [PPM]
Copper (as Cu) [PPM]
Lead (as Pb) [PPM]
Free Chlorine (as Cl2) [PPM]
Conductivity (µS/cm)
Langelier Saturation (SDI)
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Has your water system been tested for PFAS (AKA "Forever Chemicals")?
Yes, Upload Water PFAS Testing Report Files
Yes, Manually Enter PFAS Test Results
No
PFAS Testing
Please contact your Hawkins Representative to conduct water sampling and PFAS testing.
Upload PFAS Analysis Reports:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Or Manually Enter PFAS Levels:
Rows
Source 1
Source 2
Source 3
Source 4
Source/Well Name
PFOA (MCL: 4 PPT)
PFOS (MCL: 4 PPT)
PFHxS (MCL: 10 PPT)
PFNA (MCL: 10 PPT)
HFPO-DA (GenX, MCL: 10 PPT)
Hazard Index ( < 1 )
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Equipment Details
Interested in (select all that apply):
Renting Equipment
Purchasing New Equipment
Purchasing Used Equipment
Pilot Study
Filter Media Replacement
System Evaluation or Operational Review
Default Today:
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Pricing Due Date:
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
What is the rental term?
Enter length of time that equipment needs to be rented.
What is the pilot term?
Enter length of time that pilot needs to run.
Next Step:
Preliminary Review of Treatment Options
Budgetary Estimate
Firm Proposal (Bid Issued)
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Utilities
Drainage Accessible for Backwash Discharge:
Storm Sewer
Sanitary Sewer
Settling Pond
No Drainage Available
What is the drain size & capacity?
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Execution
Required Startup Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Where will the equipment be installed?
Please Select
Indoors, Controlled Environment
Indoors, Uncontrolled Environment
Outdoors, Protected
Outdoors, Unprotected
Installation Site:
Rows
Length [ft]
Width [ft]
Height [ft]
Installation Space
Installation Site Access:
Rows
Width [ft]
Height [ft]
Doorway or Entry Access Restriction
Discharge Pressure:
Does the treatment system need to discharge into pressurized distribution? If discharging to open tank, enter 0 PSI.
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Are you currently under contract with an Engineering Firm?
Yes
No
Name of Engineering Firm:
Engineering Firm Contact:
First Name
Last Name
Engineering Firm Email Address:
example@example.com
Do you need assistance in finding an engineering firm?
Yes
No
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Operating Cost Estimate
WaterSurplus builds equipment designed to use less energy and waste less water. Enter the utility rates at your facility so that we can estimate operating costs.
Incoming Water Rate [$ per 1,000 gallons]
Sewer Rate [$ per 1,000 gallons]
Power Rate [$ per kWh]
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Your Existing Equipment
Please describe current treatment equipment in place:
Are you interested in learning about selling used equipment?
Yes
No
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Submit
Should be Empty: