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Cooling Tower Survey

(Use ONE form per tower)

 Date: ________________

Client's Name:


Phone: _______________________

FAX: _________________________

E-Mail: ________________________

Send Instructions and/or Reports to:

Send copies of Instruct/ Reports to:

Service Representative:

System Description

Manufacturer's Name of Tower/Chiller, etc._____________________________Type:___________

Mfr's. Name: Compresser and Refrigerant System:

Operation: Hrs/day___Days/wk___Continuous___Intermittent_____________

Rated Tonnage of Tower_______________Water Recirculation Rate_____GPM

Dimensions of Pan: Width_________Length_________Water Depth________________________

Materials of Construction:

System Flow Diagram (attach)

Site Conditions/Water Source


Draft: Forced__________________Induced______________Natural________________________

Source of Makeup Water (City, Well, Softened, etc.):

Amount of makeup used per 24 hours_______________

Makeup line pressure (ps__________________________

How is Makeup Controlled? Float__________________Manual____________________________

Is there Provision for Bleed?_____Rate and Location_____________________________________

Is a Feeder Present?______Type__________Location___________________________________

Results of Analysis: TDS____ Conductivity____ (mmho)____ TH____ CaH____

MgH____ Turbidity____ M____ P____ pH____ Cl____ SO4____ SiO2____

Langelier Index____

Current Treatment Program:

 System  Manufacturer  Formula  Lbs/day  Cost/lb  Feeding Point

Current Chemical Control Testing

Control Tests Frequency of Plant Tests  Limits of Plant Tests   Open Recirculation Tests Closed Recirculation Tests   Once Through Tests

Corrosion Monitoring Program:

Condition of Equipment:

Closed System
Chemical Feed System

How will Alken-Murray treatment be fed into the system?

What is Cooling Water Used For?

Present Condition of System (Scale, Slime, Mud, etc.)

Temperature of influent water (water to tower)______F.

Temperature of effluent water (water leaving the tower)____F.

How Frequently is the System Cleaned - (Method)?

Effluent Disposal

Is an NPDES Permit in Effect? Yes No

Receiving body

Pre or Post Treatment

Restrictions/Permit Effluent Limits:

Dilution Water Available:

Miscellaneous Notes


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