ࡱ> JLIQ  bjbj 4>eiei  $<$? l@@U777.777VcW." k0 a!a!a!47@@a! : FORM 1 TECHNICAL APPLICATION FOR A NEW OR UPGRADED FLUORIDATION SYSTEM Water utility:Water supply:Fluoride plant location:Is supply currently fluoridated? Yes ( No (Type of works:Upgrade to existing system ( Replacement of existing system ( New fluoridation system ( Change in chemical concentration (Plant designer:Contact details:Is utility seeking subsidy for the works? Yes ( No ( (Refer to Fluoride Capital Works Subsidy Guidelines)Submitted by: (Water utility Director)Contact details:Date: Employee responsible for supervision of addition of fluorine: Name: __________________________________________________________________ Qualifications: ___________________________________________________________ Name of proposed operator or operators: _________________________________________ List qualifications of each proposed operator: _____________________________________ Approximate number of persons to be served: ____________________________________ Towns and municipalities to be served: _________________________________________ Estimated water consumption in megalitres per day: Min. Avge. Max. _________________ Instantaneous flow rate at point of fluoridation with plant operating: Min. Avge. Max: _________________ 7. Gravity or pumped supply: ___________________ List of other chemicals now used in treatment of supply: ________________________________ What provision, if any, exists for the testing and control of the water supply: ________________ Proposed location of fluoridation equipment: _________________________________________ Location of precise point of fluoridation: _____________________________________________ Provide a drawing showing the location of the fluoridation plant, the proposed fluoride dosing point, the water flowmeter, fluoride dosing interlock (eg. Flows witches) Describe flow signals to be used to provide automatic control of the starting and stopping of the fluoride dosing system including interlock of signals (describe type of meter to be used and other hydraulic details pertaining to the automatic control of specific fluoridation equipment not clearly shown on plans): ________________________________________________________________ Method to be followed in preventing back-siphonage or backflow of fluorine solution into potable water supply serving chemical feeder: _____________________________________________________________________________ Name of manufacturer of equipment: _______________________________________________ Dry feed fluoridation equipment: Capacity in kg/24 hrs with plant operating Min. _______________________________Max ____________________________. Solution feed fluoridation equipment: Capacity in L/24 hrs with plant operating Min.________________________________Max____________________________. Fluoridation chemical to be used: ________________________________________________ Type of toxic dust respirators to be used: ___________________________________________ (a) Details of equipment used for metering quantity of water fluoridated: _______________________ (b) Date of installation of metering equipment: ______________________________________ Method to be used in testing water for fluoride content: ________________________________ GHIWXYZghij    ! 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