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CITY OR AGENCY

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NAME E-MAIL

PHONE EXT# FAX

LENGTH WIDTH TOTAL WATER/SLUDGE DEPTH

ESTIMATE OF BOTTOM SEDIMENT IN FEET BOTTOM SOLIDS PERCENTAGE

YEAR LAGOON WAS BUILT YEAR LAST CLEANED   LAGOON MIXING Air None Aerators Other

LAGOON CONSTRUCTION Concrete Asphalt Packed Earth Liner Packed Clay SUMP OR PUMP OUT BASIN Yes No

TRUCK ACCESS TO DIKES Yes No   DIKE CONSTRUCTION Concrete Asphalt Packed Earth Gravel on Earth

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 LAGOON

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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Copyright © 2001 [North American Digester Cleaning Services]. All rights reserved.
Revised: 03/23/07.