Boiler Water System Evaluation

Please complete one form per boiler. Click on Submit when ready to send.

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In response to numerous requests for test kit and meter supplier information, we have added the links below: 


  La Motte


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Company Name:

Client or Distributor's E-mail address:



 Telephone Number:  

 Contact: (Name & title)
 AM Distributor  

Send instructions/reports to:


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System Description

Boiler Number

Make of Boiler 

Water tube or Fire Tube 

Horse Power or pounds of Steam/Hour


Hours Operated/Day


Fuel Type used 

Stoker or Burner Type Used 

Main Fireside Problem 


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Site Conditions - Boiler Water Analysis

Days of operation/week:


Steam Pressure: psi

Fire Box Temp: Degrees F Degrees C

Average Daily Fuel Consumption: Summer Winter

Can Stack Damper Be Closed? Yes No

How is soot and fire scale removed?


Frequency of Removal:


Oil storage tank capacity:US gal Liters

Number of tanks:

Condition of oil system:

Oil preheat temperature: Degrees F Degrees C

Source of makeup water for boiler: City Well River Other (Specify)

Is softened water used for boiler make-up? No Yes - type: Zeolite Demineralized Cold lime-soda Hot lime-soda Other (Specify)

Boiler water treatment is added by this method (check all that apply) Directly to the boiler Injector Bypass feeder From makeup tank From return condensate tank Chemical Pump Other (specify)

Boiler blowdown schedule: A.M. P.M.

How often is boiler washed?

Heater type: (check all that apply) Open Closed Vented Dearating None

Length of feed line from point treatment is added to the boiler:feet meters

Condition of feed line

Are any of these problems present in the boiler-water? Foam Prime Surge

Summary of boiler inspectors report:

Present condition of water side of boiler: (check all that apply) Scaled Corroded Pitted

Other (describe)

State all purposes for which steam is used. Please be specific. For instance, "processing" would be too generic as a description.

How will the sample of return condensate be taken?

How and where will any of the Alken Treatment-J series be introduced?

Present condition of steam lines:

Where is steam lost?

Does engineer have boiler water testing equipment? No Yes - Manufacturers, models, & tests covered):

This survey was conducted for the following reasons: Proposal Letter Lab records Other


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Flow Diagram

 You may submit a diagram by FAX at 540-636-1770 or give us a word flow chart below

Example: raw waste pump station --> pond 1 (aerated, lined) --> ponds 2, 3 ,4, & 5 (settling and unlined) --> sludge holding pond


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Current Treatment Program:
 System  Manufacturer  Formula  Lbs/day  Cost/lb  Feeding Point

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Incoming (Make-up) Untreated Water

 Analysis  Survey Results  Variation  Analysis  Survey Results  Variation
 Source  NaCl
 "P" Alkalinity  TDS
 "M" Alkalinity  Fe
 Calcium Hardness  SiO2
 Total Hardness  pH

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Boiler System (Feedwater) ...............Steam Characteristics
  Analysis Survey Results  Variation  Observation  Survey Results  Variation
 "P" Alkalinity  psig
 "M" Alkalinity  Temp: Steam
 Total (Acid) Hardness   Water
 NaCl  Oxygen: Rated
TDS  Actual oxygen
 % Make-up  Load: (lb/day)  Summer  Winter

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Condensate Characteristics

 Analysis  Survey Results  Variation
 Iron (total or insoluble)
 % Return

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Boiler Water Controls

 Analysis  Survey Results  Recommended Levels
 "P" Alkalinity
 "M" Alkalinity
 "OH" Alkalinity
 PO4 or Chelate Residual

 Other (Fe, Si, Oil, etc.)

Testing Frequency (check ONE) shift daily weekly monthly none

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Effluent Disposal
 Is an NPDES Permit in Effect? Yes No
 Receiving body
 Pre or Post Treatment
 Restrictions/Permit Effluent Limits:
 Dilution Water Available:

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Miscellaneous Notes

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We usually add all people who inquire about our products to our newsletter mailing list, which is kept for in-house use. We do not ever sell or trade names of our clients, and rarely contact by e-mail more than once a month.

Mailing list: YES NO

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Alken-Murray banner link to homepage

click here for original format survey form to print and faxfor original format to print, fill-in with a pen and fax