| Company*: |
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| Job Name*: |
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| Contact*: |
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| Address*: |
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| Phone*: |
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| Contact: |
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| Phone: |
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| Is swimming or boating permitted in the water source?: |
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| Total gallons per minute (gpm) of pump station?: |
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| Water source (pond, lake, river, stream, etc): |
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| Distance from shore to adequate water depth: |
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| Water depth from normal pool to lake bottom: |
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| Water depth from highest pool to lake bottom: |
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| Water depth from lowest pool to lake bottom: |
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| Distance from pump equipment to water's edge: |
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| Intake manifold (type of pipe, i.e., pvc, steel, CMP): |
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| End of intake piping (flanged, open, etc.): |
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| Elevation change (pump slab to normal water pool): |
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| Elevation between normal water level and concrete slab: |
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| Do you need pricing and/or information on an automatic vacuum priming pump: |
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