Home / Membrane autopsy request
Client/Company name *
Contact name
Title
Phone number *
Email address *
Billing address *
Mailing address (if different from billing address)
Sales person (enter name of representative or N/A if you don’t deal with a PWT rep) *
Other person to email the final report to (name)
Email address
Requested work *Full RO/NF element autopsyFull MF/UF element autopsyCartridge filter exam
Optional workDye examination (sheet)Dye examination (membrane)FujiwaraGas chrom / Mass spec.Bart analysisMicroscopic analysisBackscatter SEM
Additional workStandard Water analysisStandard Wastewater analysis (membrane)MLSS (sludge) analysisDeposit analysisWhole Rock
Special request Faster Service (X 1.5)Analysis results within 10 days of receiving the sample, autopsy report within 15 days Urgent Service (X 2.0)Analysis results within 5 days of receiving the sample, autopsy report within 10 days
Reason for work request *
Manufacturer *
Model *
Element location in system *
Element age *
Any current damages to exterior of the membrane? *YesNo
System configuration *
System product water flow rate - designed (gpm, m3/d, MGD) *
System product water flow rate – actual (gpm, m3/d, MGD) *
Feed conductivity *
Permeate conductivity *
Differential pressure – design *
Differential pressure – actual *
Feed pressure – design *
Feed pressure – actual *
Special request (return the membrane, return membrane samples, additional analytical testing, etc.) *
Special instruction, additional information
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