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Water Quality Member
Please complete the following form and submit with your request for system quotation, or download and complete the PDF copy and fax it to Pure Yemen, Inc. at
CONTACT INFORMATION
Contact Name
Company Name
Address
City/State/Zip
Phone Number
E-Mail
Today's Date
Fax Number
Web Site
Need Quotation by (Date)
Application
Required Equipment
Feed Water Source: Well Municipal/Tap Surface (River/Lake) Seawater Other
Residential (up to 200 gal/day) Commercial (200-10,000 gal/day) Industrial (above 10,000 gal/day)If you know your specific requirements, please specify:
Filtration Softeners Reverse Osmosis Ultraviolet DI / EDI Ozone Other
Product Water Repressurization Needed?
Yes No
Required System Capacity
Gallons/Minute Gallons/Day Cubic Meters/Hour
Available Power
115V/1Ph/60Hz 220V/1Ph/60Hz 220V/3Ph/60Hz 460V/3Ph/60Hz 380V/3Ph/50Hz 220V/1Ph/50Hz 415V/3Ph/50Hz
FEED WATER ANALYSIS INFORMATION
Temperature
pH
TDS
Suspended Solids
Turbidity
Conductivity
Color
Total Hardness
WATER ANALYSIS - Ionic - Should Be a Balanced Analysis
Ca++
CO3--
Mg++
HCO3-
Na+
SO4--
K+
Cl-
NH4++
NO3-
Sr++
F-
Ba++
SiO2
Fe++
Other
Mn++
