INFORMATION NEEDED FOR WATER CONSERVATION STUDY:
COMPLETE (please use black ink), COPY AND FAX TO 888-367-5556 (no cover needed) OR
SCAN AND E-MAIL TO info@ecotechwater.com

NAME OF PROPERTY: __________________________________________________________________

Address: ___________________________________City___________________State____Zip________
Person providing information:

Name__________________________________________________Title____________________________

Ph____________________Fax_________________E-mail_______________________________________

Type of property: ______________________________________________________________________


APPROXIMATE USER INFORMATION:

• Number of male plumbing users: Residents:__________ Customers:___________ Staff:________
  Students:_________ Patients:___________ Visitors/Guests:__________ Other users:_____________
• Number of female plumbing users: Residents:________ Customers:___________ Staff:________
  Students:_________ Patients:___________ Visitors/Guests:___________ Other users:____________

FIXTURE AND FLOW RATE INFORMATION:

• Number of urinals on the property: ADA________ STD_______ Gallons per flush: _____________
• Number of toilets on the property: ADA_________STD_______ Gallons per flush: _____________
  # Floor mount ______ # Wall mount _______ # Flush valve type_______ # Tank type___________
• Number of showers on the property:________ Flow rate in GPM (gallons/minute): __________
• Number of sinks on the property: Hand_____ Flow rate GPM____ Commercial ____GPM_____
• Number of days per year property is used: _________ Number of hours per day_____________
• Water uses other than toilets/urinals-sinks-showers: Cooling tower______ Laundry________
  Dish Washing______ Ice making #'s per day______ Other______________________________________
• Water source for irrigation:_____________ If from utility co. is there a separate meter______
• Estimated gallons of water consumed per year_______________ Number of meters__________
• Name of sewer & water utility co.: __________________________________________________________
• REMARKS:_____________________________________________________________________________________

PLEASE ATTACH A COPY OF A RECENT WATER AND SEWER BILL FOR A TIME PERIOD THAT REFLECTS A "NORMAL" MONTH OF USE.