SYSTEM QUESTIONNAIRE ™

Sales Rep:

SITE INFORMATION
Company Name: Contact Name:

Site Name: Phone:

Address: Email:

Type of Industry: Work Order#:

SITE ISSUES
Primary Issue: Location:

Secondary Issue: Location:

Additional Comments:

ELEMENT INFORMATION
MANUFACTURER MODEL SERIAL NUMBER RO TYPE STAGE POSITION AGE

PLANT FLOW SCHEME (Please indicate all equipment and chemical injections of your process)

FOR EXAMPLE
Raw Water Tank Cartridge Filter Vitec RO

LIST CHEMISTRIES FROM THE PLANT FLOW SCHEME PRODUCT MANUFACTURER AND NAME DOSE RATE
pH Adjustment
Biocide
Oxidizer
Coagulant/Flocculant
Antiscalant:
Chlorine Scavenger
Other:

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RO DESIGN (Fill out for each RO indicated in the flow scheme)

RO Type: Designed Feed Flow: MEMBRANE ARRAY (#/STAGE)

Reject Recirculation? Y N Designed Permeate Flow: Stage 1st 2nd 3rd
Under Warranty? Y N Current Permeate Flow: Pressure
Vessels
Warranty Expires: Current Recovery:
Elements
Equipment Supplies: per Vessel

Flux Balancing: Interstage Booster Location: Permeate Back Pressure Location:

RO Type: Designed Feed Flow: MEMBRANE ARRAY (#/STAGE)

Reject Recirculation? Y N Designed Permeate Flow: Stage 1st 2nd 3rd

Under Warranty? Y N Current Permeate Flow: Pressure
Vessels
Warranty Expires: Current Recovery:
Elements
Equipment Supplies: per Vessel

Flux Balancing: Interstage Booster Location: Permeate Back Pressure Location:

RO OPERATION
Days/week of operation: Hrs/day/train of operation:

Pre flush? Y N Post flush? Y N Flush water source:

RO CLEANING
Reason: Flow Decrease Normalized Flow Decrease Loss in Rejection

Scheduled/Maintenance Differential Pressure Increase Other:

Cleaning Frequency: Date of Last Clean:

Stages Cleaned Separately? Y N Cleaning Solution Heated? Y N Target Temperature:

Cleaning Chemicals: PRODUCT NAME PH DURATION

Alkaline

Acid

Other

CIP Dilution Water Source: Cleaning Flow Rate per Vessel:

Post Clean Change in Flux and DP: Membrane Replacement Frequency:

CARTRIDGE FILTER
Micron Rating: Nominal Absolute

Frequency of Filter Replacement: Total Number of Filters:

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FEED WATER Parameter Ranges Low High
Water Source: RO Feed Turbidity (NTU)
Permeate Application: Feed pH
Temperature
Chlorinated? Y N

DETECTION RECOMMENDED
ANALYTE AS ION (mg/L) LIMIT (mg/L) DETECTION LIMIT (mg/L)

Sodium 0.10

Potassium 0.10

Calcium 0.03

Magnesium 0.03

Iron 0.02

Manganese 0.005

Barium 0.01

Strontium 0.01

Aluminum 0.01

Ammonium 0.10

Chloride 2.00

Sulfate 5.00

Bicarbonate 0.30

Carbonate 0.04

Nitrate 0.06

Fluoride 0.10

Silica 0.01

Feed TDS

Permeate TDS

Concentrate TDS

Additional Element Requested:

Additional Element Requested:

Additional Element Requested:

Additional Element Requested:

Additional Element Requested:

Comments:

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San Marcos, California 92069, United States

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