Fax or mail this completed form to the water treatment specialists at Tramfloc for a customized proposal.

Date: ________________________

Company Name: _________________________________________________________

Contact: ________________________________________________________________

Address: ________________________________________________________________

City: ___________________________________________________________________

State or Province: _________________________________________________________

ZIP or Postal Code: __________________ Country: _______________________

Telephone: __________________________ Fax: _______________________________

Type Water to be Treated: ___________________________________________________
System ID: _______________________________________________________________
Main System Flow Rate: Mean: ______ Min: _______ Max: __________ GPM or GPD
Does Flow Rate Fluctuate? No _____ Yes _____ Range (GPM)_________________
Main System Water Pressure: Mean: _______ Min: _______ Max: _________ PSIG
Does Pressure Fluctuate? Yes______ No ______
Desired Chlorine Residual: ___________ PPM
Chlorine Demand: _________PPM Chlorine Tablets Require _______________LBS/HR
Source Water Supply to Chlorinator System:
          Mean: _________ Min: ________ Max: ________ GPM
Is the line always full? Yes ______ No ______
Desired Water Flow Thru Chlorinator: _____ GPM
Pressure of Water Supply to Chlorinator System:
          Mean: _______ Min: _______ Max: _________ PSIG
Chlorinator System Discharge Pressure: Mean: _______ Min: _______ Max: _________ PSIG
Duty cycle________________ Cont.______________ Int.________________________
Hrs/Day Available Electrical Supply: Volts: _________ S: _________ Phase: ________
How Will the Chlorinator System be Controlled? Manually: _____ Automatically: _____
Source Water Characteristics:
           pH: _____ Total Alkalinity: _____ Calcium Hardness: _____ Temperature, ^oF:______

Person Certifying Data: _____________________________________________________

• Patented Tablet Feeder (NSF STD 61 Certified)
• Integrated, Level Controlled Solution Tank Adjustable Flow Control Valve
• Chlorinator Flow Meter
• Efficient Centrifugal Solution Pump On/Off Control Switch
• Waterproof Electrical Junction Box NEMA 4 Rated
• Corrosion Resistant Schedule 80 Piping
• Reverse Flow Check Valves
• Total Solution Output Control Valve

____ Scale Inhibitor Option
____ Flow Proportional Control (Flow Pacing)
____ Inlet Flow Meter
____ Low Inlet Pressure Boost Pump
____ ORP or Residual Chlorine Controlled
____ Start Delay Timer
____ Custom Inlet Outlet Fittings
____ Inlet Supply Line Pressure Regulator
         with Pressure Gauge
____ Complete SCADA System
         Performance Tie-In
____ Flush Manifold Kit
____ Inbound Filter
____ System Output Meter and Pressure Gauge
____ Electronic w/4-20 mA Output
____ Visual Rotometer
____ Low Tablet Signal Alarm