DATA COLLECTION SHEET FOR

COOLING WATER TREATMENT PROGRAMME

NEW CLIENT / NEW APPLICATION

S.N

/

Details

/ Description
1.  / Client Name, Full Postal Address, pin code with Phone Number(s)
2.  / Attention to whom
3.  / Subject
4.  / Our Sales Executive (s) involved
5.  / Discussion over phone / direct site visit
6.  / Discussed with whom
7.  / Offer to be sent through mail / Fax / Courier / Mail Id :
Fax No :
Courier Name :
8.  / Copies to be sent to (ie CC to)
9.  / No.of Cooling Towers / Working : Standby :
10.  / Type of System ( use Tick Mark) / Open / Closed / Once-Through
11.  / Type of cooling tower (Use Tick Mark) / Natural Draft / Forced / Induced Parabolic / Spray Pond
12.  / Recirculation Rate m3/hr
13.  / No.of Pumps working
a.HP of pump
b.Head in Mtrs of Pump
c.Pressure of the pump
14.  / Difference in Temperature (DT) in Degree C / Inlet / Outlet
15.  / Holdup Volume of sump m3

S.N

/

Details

/

Description

16.  / Cycles of concentration (COC)
17.  / Evaporation Loss m3/hr
18.  / Bleed off m3/hr
19.  / Makeup water quantity m3/hr
20.  / Makeup water quality
21.  / Metallurgy of the system available
22.  / Availability of chlorination system / Yes / No
23.  / Whether any acid dosing system is there? / Yes / No
24.  / Residual free chlorine level maintained in recirculation water
25.  / Availability of corrosion test rack / Yes / No
26.  / Whether cooling towers are interlinked / Yes / No
27.  / External Treatment / - 
28. 
/
Water Characteristics
TDS ppm
PH
Total Hardness ppm
P.alkalinity ppm
M.alkalinity ppm

S.N

/

Details

/

Description

29.  / Recommended product (s)
30.  / Dosage
31.  / Price
Special Instructions ( If any)
Date of Visit by you
Offer sent Date to Client
Signature of the Sales Executive

Special Notes: Kindly note that if the space provided above is not sufficient, then use reverse side of this paper for giving more details.

WASSER CHEMICALS & SYSTEMS PRIVATE LIMITED.