Residential Water Analysis Report

Water Analysis Report

Please answer all questions to ensure an accurate equipment recommendation.
Customer/Homeowner Information
Customer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Dealer/Plumber Information
Dealer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Distributor/ Wholesaler Information
Distributor Name
Address
Street Address
City
State/Province
State/Province
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

1. WATER SOURCE
Type of Water Source

Other
What is the source of the cistern?
What is the age of the well (years)?
Pumping Rate of Pump (GPM):
If unknown, enter "unknown". The recommendation will be based on a 5 gpm flow rate
HOW TO MEASURE PUMPING RATE OF PUMP

1. Make certain no water is being drawn. Open spigot nearest pressure tank. When pump starts, close tap and measure time (in seconds) to refill pressure tank. This is cycle time.

2. Using a container of known volume, draw water and measure volume in gallons until pump starts again. This is drawdown.

3. Divide drawdown by cycle time and multiply the result by 60 to arrive at the pumping rate in gallons per minute.

2. HOUSEHOLD INFORMATION
What is the intended application?
Since this water supply will require a commercial application, please select the link below to fill out the Commericial Water Analysis Form.

Commercial Water Analysis Form
Is there water conditioning equipment installed?
Please provide the type and size of equipment installed.
Photo of Equipment

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Number of people:
Number of bathrooms:

Additional Comment(s):
Please write the customer's name on the bottle with a permanent marker and submit a photo of the bottle with the name below. After submitting the form, you'll receive an email with a unique ID. Write this number on the bottle's lid with a permanent marker and, if you have a paper copy, in the top left corner under “QR Sample ID#.”
Please upload a clear photo of the water sample(s) with the customer's name written on the bottle to ensure proper identification.

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Should be Empty:

Welcome!