Fluid Systems Environmental Questionaire

Fluid Systems

Skimmer Applications Work Sheet

Describe Your Application in General

Describe Factors that may Affect
Skimmer Head Selection (Plastic vs. Stainless Steel)

Facility
Sump	Ditch	Pond/Lagoon	Oil/Water Separator
Other --> Describe:
Skimming Area Size Height x Width x Length

Must All Product be Removed from the Surface?
Yes	No
Only Pure Product Removal Required? (no underlying liquid)
Yes	No
If YES, the Residual Floating Product Surface Layer Depth Should Be:

Liquid pH is:
If pH is Other than 7, what is the cause of change?
Acidic	Caustic	Other
Describe:

Does Tank Liquid Level Change?
Yes	No
High Level Normal Level Low Level
Desired Skimmer Head Flow Rate: (gph or lph)
Normal Ambient Temp: (f or c)
Peak High Temp: (f or c)

Is a Pump Required?
Yes	No	On Hand
If On Hand, Please Describe the Pump
Diaphragm	Centrifugal	Progressive Cavity
Other --> Describe:
-->Gas -->Diesel -->Electric -->Air -->Hydraulic
TDH	Power	GPH
Port Size	Suction Elevation	Discharge Elevation
Distance from tank

Date System is Required at Work Site
Contact Information
Name:
Email:
Company:
Address 1:
Address 2:
City:		State:
Country:		Zip:
Telephone:		Fax:

Industrial Applications	Pollution Response
Fixed Weir Skimmers	Spill Kits
Flow Control Skimmers	Booms & Sorbant Material
Smart Skimmers	Separators
Industrial Questionnaire	Environmental Questionnaire

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whenever it deems the quote is not feasible. There is no obligation, by sending this request, to purchase from Fluid Systems