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Lift Station Diagnostic Form

Just complete one form for each lift station. Click on Submit when ready to send.

For this form to work, check that the URL address of the Frame reads


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Your name:

Your E-mail address:

Company Name:  

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 Capacity of Lift Station (# of gallons)
 Daily influent ( if known)
 Influent pH
 Effluent pH
 BOD5 in mg/l
 COD in mg/l

 Hydrogen sulfide odor present? YESNO

Has hydrogen sulfide been detected by test? YESNO

 How thick is the grease cap?
 Any problem with copper, lead, mercury? YESNO

 Is this typical food waste? YESNO

If waste is unusual, check any of the items listed below or add your own comment:

  • More pastries than usual
  • More bacon and other fat
  • Extra cleaning compounds used
  • Other

 How often are disinfectants used?

Do the disinfectants empty directly to this station? YESNO

 Other than meeting discharge regulations, are there any other treatment goals?

  • Goal of odor control
  • Goal of clearing clogged pipes
  • goal of eliminating corrosion to pipes and lift station
  • Other goals
 Discharge Permit information:  


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Questions About Current Product and How Applied
 What sort of pump is used to apply current product?

 Where does pump deliver dosage of product? (Select one or more that apply)

  • Under surface
  • Over surface
  • In one corner of the lift station

 How often is pump set to deliver product dosage? (Check one)

  • every 15 minutes
  • hourly
  • daily
  • twice a week

Describe any other adjustments possible:

 Name of the current product being used ?

Why are you dissatisfied with current product?

 Did you use any other products before current product? YES NO

How did you compare with your current product?

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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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click here for a link to the print and fax version of the formfor the old "print and fax" version of this form

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