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Field Service Work Questionnaire

Company Name: System Site Address: Site Contact Person: Site Contact Phone Number: Proposed Date of Exchange Number of Units: Quantity of Carbon (per unit): Is system used for a liquid or vapor application?

liquid vapor

Carbon Product Name: Currently Installed Mesh Size: Is spent carbon RCRA Hazardous?

yes no

Is spent carbon to be disposed and/or reactived by CCC?

yes no

Are there other medias involved (sand, gravel, etc)?

yes no

If yes, please indicate type, size, and quantity: Is site-specific safety training required?

yes no

Is this a Food Grade or Potable Water Application?

yes no

When was your last exchange?

by slurry by vacuum

Is spent media free-lowing?

yes no

Were there any problems during the last exchange?

yes no

If yes, please explain: Is a crane or forklift available?

yes no

Is there a staging area for equipment and carbon?

yes no

Is there a staging area for equipment and carbon?

yes no

Is vessel inspection and/or repair by CCC required?

yes no

Vessel location:

indoor outdoor

Distance from equipment (truck) to vessel in feet: Size and type of connection fittings and location on tank (threaded, male, female, camlock): Height of top of vessel from ground level: Head room about vessel for loading: Manhole size(s) and location(s): Additional information or comments: