Please complete, then print the form. Mail or fax to

Xitech Inc.
06 Camino De Los Desmontes
Placitas, New Mexico 87043
United States
Phone: Toll Free 1-888-867-9483
fax: (505) 867-0212

Groundwater Pumping Free Pilot Site Questionnaire

  

Contact:*   

Company:*  

Phone Number:*     Email:*  

1. Does your pilot well have an existing groundwater pump? Yes No

If No: Proceed to question #2

If Yes: What gallons per minute do you require? (gpm)
At what depth will you be placing our GW pump? (feet)

What is the INSIDE diameter of the air supply line? (inches)

What is the INSIDE diameter of the air exhaust line? (inches)

What is the INSIDE diameter of the water discharge line? (inches)

2. What is the diameter of your well?  (inches)

3. What gallons per minute do you require? (gpm)

4. At what depth will you be placing our GW pump? (feet)

5. What type of pumping are you interested in piloting?

Dissolve Phase pumping(single pump):    
Total Fluids pumping(single pump):     
Total Fluids pumping (Skimmer + pump):    

6.  Is your well casing material:  Metal or PVC

7.  When would you like to install the pilot equipment? (date)

8.  What is the name of this site?

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Xitech Inc.  06 Camino De Los Desmontes  Placitas, New Mexico 87043 United States
Phone: Toll Free 1-888-867-9483  | fax: (505) 867-0212