Name:     Company/Org.:

Phone:   Fax:    Email:

Address:

City:   State:   Zip Code:   Country:

Installation Location:  Indoor    Outdoor:

Flow Rate (max): GPM,   (Average):GPM   (min):GPM

UV Transmissibility of Fluid:%  Required Minimum UV Dosage:

Pre Treatment (type): 

BOD: mg/l

Power (available): VAC   Hz   Amps

Lamp Type Desired:  

Std. Low Pressure    High Output Low Pressure    Medium Pressure    No Preference

Chamber/Channel Material: 304 St. Stl.  or 316 St. Stl.

Channel Dimensions. Width:   Height:  Length:  

Size Restraints (if any): 

Weight Restraints (if any): 

Temperature:  Operating    Max.    Min.

Relative Humidity:  %

Accessories Desired:

Additional Information:

Clean Water Systems International
Copyright © 1999 C.G. Romary and Son, Inc.  All rights reserved.
Revised: 08/03/01