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Forms > Industrial Wastewater Sample Request Form

For a PDF version of our Water Sample Form, please click here. Send physical samples to ECOLOGIX ENVIRONMENTAL SYSTEMS, 11800 Wills Road, Suite 100, Alpharetta GA 30009. An email or faxed version of the below form MUST accompany sample.

Your Contact Information
Please briefly describe your project requirements *
Company Name
Contact Name (First/Last) First: Last:
Street Address
City, State, Zip City: State: Zip/Postcode: Country:
Phone / Fax Phone: Fax:
Email
Project Information
Project Name
Project Location
Please provide as much data as possible
  Influent Levels Effluent Levels
Avg Range Avg Range Permit
Flow in Gallons
Temperature
pH
Dissolved Oxygen (mg/L)
BOD - Biological Oxygen Demand (mg/L)
COD - Chemical Oxygen Demand (mg/L)
TSS - Total Suspended Solids (mg/L)
FOG - Fat, Oil & Grease (mg/L)
TPH - Total Petroleum Hydrocarbons (mg/L)
Chrome (Cr)
Copper (Cu)
Zinc (Zn)
Lead (Pb)
Flexographic Ink
Other
Other
Please provide a description of the current system and operating conditions:
Please provide background description of the problem

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