Date: ________________ Client: __________________________________________________________ Address: ________________________________________________________ _______________________________________________________________ _______________________________________________________________ Phone: _______________________ FAX: _____________________________ E-Mail: _________________________________________________________ Pond/Lake Name:_________________________________________________ Service Representative:_______________________________________________ Surface Area: ______ acres Average Depth: ____ ft. Water Source:___________________Outflow:(as % of total water in lake / pond) _______% Location:(Describe pond location in words or with a diagram, on the back of this page, for your reference.) Offensive odor? no yes How strong? ______ Ammonia? no yes Sulfur? no yes Water color and appearance: ________________________________________ Runoff: no yes Source:______________________________________________ Sludge:_________________________________________________________ Chemicals / pesticides added to lake / pond or runoff:_______________________ _______________________________________________________________ Waterfowl:_____________________Algae:_____________________________ Livestock:_____________________Fish:_______________________________ Aquatic plants:_____________________Recent fish mortalities? _____________ Mechanical aeration? ______________________________________________ Describe other treatments and when applied:_____________________________ _______________________________________________________________ Dissolved oxygen - Noon:_____ ppm Before Dawn:_______ppm pH: ______ @ ______F Alkalinity:______ ppm Hardness:______ ppm Chloride:______ ppm Ammonia nitrogen (NH3):______ ppm Nitrite: ______ ppm Nitrate: ______ ppm Carbon dioxide:______ ppm T Temperature:______ F ____________________________________________________________________ Chlorine (free): ______ mg/l Chlorine (total): _____ mg/l Copper (total soluble): ______ mg/l Iron: ______ mg/l Lead: ______ mg/l Mercury: ______ mg/l Tributyl tin: ______ mg.l Cyanide:______ mg/l Detergents: ______ mg/l Phenol:______ mg/l Sulfite: ______mg/l Hydrocarbons_____mg/l Pesticides (name chemical tested______________________________________)_______ mg/l FOG_____ mg/l Phosphate:______ mg/l Ammonia Salt (NH4): ______ mg/l BOD:______ mg/l COD: ______ mg/l |
Date: ________________ Client:______________________________________________________________ Lake/Pond:__________________________________________________________ Water Chemistry Adjustment: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Mechanical Treatment (Aeration, etc.): ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Alken Clear-Flo® Treatment: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Follow Up and Other comments: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ |
Draw a sketch of the pond. Be sure to indicate concrete or earthen bottom, location of inflow/outflow, special characteristics:
