Wastewater Lab Analysis Form

Company:(Required)

Date collected:(Required)

Testing authorized by:(Required)

First Last

Name of Sample:(Required)

Phone:(Required)

Sample collected by:(Required)

Email:(Required)

What level of testing would you like?(Required)

Microanalysis & Filament Origins (Fill 1/2 bottle for each area tested)

Testing not listed: contact your rep for pricing, recommendations, and instructions

Testing name:(Required)

First Last

FOR EXPEDITED TESTING AND OTHER SPECIAL REQUESTS PLEASE CALL 888.466.0031

(Required, fill out both sides) Please answer the following:

Please circle the correct units or write in your own.

Daily Flow Rate:

Units: MGD, GPD, m3/day

Water Temp:

°F, °C

F:M

DO Level:

mg/L

Avg:

mg/L

Influent BOD:

mg/L

Effluent BOD:

mg/L

Ammonia (NH3) Levels:

In:

Units: mg/L

Out:

Units: mg/L

30 Min Settling:

% divided by 1000 ml

Effluent TSS:

mg/L

pH:

Units:

Basin/Tank Volume:

m3/day, gal

Misc.:

Problems experienced:

Foaming

Bulking

Poor BOD removal

Poor ammonia removal

Poor phosphorus removal

High TSS

Other

Please add as much additional information about your wastewater treatment plant as possible.

Effluent Limits: Summer

BOD

TSS

NH3

Total P

Effluent Limits: Winter

BOD

TSS

NH3

Total P

1) Describe what you are dealing with.

2) What chemicals are being used?

3) Water temperature:

4) What type of process do you have?

Misc. Data/Notes: