PLEASE PROVIDE ANSWERS TO ALL OF THE QUESTIONS IF AT ALL POSSIBLE

CITY OR AGENCY

ADDRESS   STATE Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP

NAME E-MAIL

PHONE EXT# FAX

TYPE OF DIGESTER Anaerobic Aerobic Other: GALLONS

DIAMETER SIDE WALL DEPTH CONE DEPTH

NUMBER OF TOP MANHOLES 1 2 3 4 4 Plus None INSIDE DIAMETER OF MANHOLES

NUMBER OF SIDE OPENINGS 1 2 3 4 4 Plus None   INSIDE DIAMETER OF OPENINGS

YEAR TANK WAS BUILT   YEAR LAST CLEANED   TANK MIXING Hydraulic None Gas

TANK CONSTRUCTION Concrete Steel   LID   Domed Flat FLOATING LID  Yes No SUMP  Yes Unknown No

LADDER OR STEPS OUTSIDE Ladder Steps None   INSIDE Yes No  ARE THEY SAFE  Yes No

CURRENT PH OF TANK TEMP IN OPERATION  Yes No

TYPE OF HEADWORKS TYPE OF GRIT REMOVAL

AVAILABLE AMPS FROM 3 PHASE 460/480 VOLTS 2nd BREAKER AMPS

(IF YOU ARE UNSURE ASK YOUR ELECTRICIAN OR CALL US....THIS IS IMPORTANT)

TYPE OF WATER SUPPLY PSI DISTANCE FROM DIGESTER

ESTIMATE OF BLANKET IN FEET BOTTOM SEDIMENT IN FEET

IS MATERIAL TO BE DE-WATERED ?   Yes No IF SO TO WHAT PERCENT SOLIDS 

IF MATERIAL IS TO BE PUMPED ON SITE HOW FAR  Feet Miles

DISTANCE MATERIAL IS TO BE REMOVED OFF SITE   HAULER   Agencies Contractors None

TYPE OF DISPOSAL SITE

AVAILABLE LIFTING EQUIPMENT ON SITE ?  Yes No WHAT KIND

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DIGESTER CLEANING  SCREENING   DREDGING   DISPOSAL   LAND APPLICATION   POND CLEANING   DEWATERING  DRYING SERVICE 

Copyright © 2001 [North American Digester Cleaning Services]. All rights reserved.
Revised: 02/16/06.