Name
      
Company
 
Address
 
City  State       Zip   
Country
Phone
 
Fax
 
E-Mail
 

Location of Application
                         

Type of Water: 
                            Raw Sanitary
                            Treated Effluent
                            Process or Industrial Discharge
                            Irrigation
                            Storm Water Runoff
                            Other

Water temp.   °F
Water pH
Chemicals Present in Water: 
                          

Solids or large debris present in flow:  No    Yes

New Construction  Existing Construction

Channel Type:
                            Natural Stream
                            Concrete Channel
                            Pipeline
                            Other 

Channel Dimensions
                           

Slope of channel or pipe

Pipe Type
O.D.    I.D.    

Depth of water in existing channel
at maximum flow rate
                           

Anticipated Maximum Flow:    (include units)
Average Flow:                            
Minimum Flow:                            

Are batch dumps, which would result in
short periods of high flow possible:  No     Yes

Maximum allowable water depth in upstream channel
after installation of flume or weir: 

A separate drawing or sketch,showing additonal details,
may be sent via E-mail or fax.

When form  is completed, please Press "Submit" button to send
to Free Flow via E-mail.