CONTACT INFORMATION

Contact Name: *

Phone Number:

Email:*

PROJECT INFORMATION

Country and City/Region:

Type of Establishment:

Number of Users:

SITE INFORMATION

Purpose and Need:
For Water and Wastewater Management System

Current Sources of Water:

Piped waterWater tankerHarvested rainwaterOthers:

Avg. Volume of Potable Water Consumed:
Per Capita Per Day

Current Wastewater Management:
System or Practices

Sources of Wastewater:

ToiletsBathing RoomsKitchensCafeteriaLaboratoriesIndustries, please specifyOthers:

Volume of Wastewater Generated Per Day:

Current Wastewater Discharge Location:

Desired Uses of Treated Wastewater:

Groundwater RechargeSafe Discharge into Rivers & LakesIrrigation/AgricultureLandscapingToilet FlushingCooling TowersOther Reuse Within Building or Community

Solution(s) Desired:

Rain Water HarvestingDrinking Water TreatmentWastewater RecoveryProtection of Rivers & LakesExtraction & Distribution SystemsSolid Waste ManagementWellness SolutionsSocial Impact - Water, Sanitation & LivelihoodsEducation - Water & Environment

Further Information & Comments: