Liquid Disinfection Request Form
Name:
Company Name:
Address:
City:
State:
Zip:
Phone:
Email:
How did you hear about
UV Connection
?
FLOW RATE
GPM
WATER TYPE:
CLEAR FRESH
WASTEWATER
PURIFIED
POND
SALT
WIPERS:
MANUAL
AUTOMATIC
NONE
PIPE INLET/OUTLET SIZE:
in.
*Please consult factory for sanitary fitting options.
Any bromide concerns?
SYSTEM BYPASS ( requires 2 or more units )
YES
NO
Notes:
1310 Rayford, Bldg. F2, Spring, Texas 77386
Tel: ( 281) 419-6112 Fax: (281) 419-6136
info@uvconnection.com
,
sales@uvconnection.com