PLEASE PRINT OUT A HARD COPY AND MAIL OR FAX TO:

Contact Person:______________________________________________________

Company Name:______________________________________________________

Street Address:______________________________________________________

City, State, Zip Code:__________________________________________________

Telephone:___________________________ Fax:___________________________

LOADING FACTORS (please answer all that apply):
Is there accumulated organic debris on bottom? Yes______ No______
Is there ever fertilizer runoff from shore? Yes______ No______
Is there a replacement water source? Yes______ No______  If Yes, Approx. Gals./Min.
What is the source of the replacement water?_____________________________
Are there organic nutrients present in the replacement flow? Yes______  No______
Are waterfowl present? Yes______ No______ - If Yes, Number______ and Type
Are fish being fed? Yes______ No______  If Yes, Approx. pounds of food/day, lbs.
Is there a filtration system present? Yes______ No______  If Yes, please describe the
filtration system including flow rate, components and any water quality problems.

___________________________________________________________________

___________________________________________________________________

What is the intended use of the pond and what water quality problems are you most concerned about? (please describe)

___________________________________________________________________

___________________________________________________________________

SITE DIAGRAM
_____________________________________________________________
Please use your site plan or provide a simple sketch of the pond.

Please provide a simple sketch of the pond to aid us in preparing an accurate design to meet your exact site requirements. Please note any deeper areas of pond/s, location/s of electrical supply and any additional pertinent features such as bridges, filtration/pump systems, large rocks, water fowl or fish feeding areas and incoming and outgoing water sources. Please add any additional information which may be helpful in describing the site, it's use and desired appearance.

Please return your site diagram and checklist via fax or mail to:

Advanced Aquaculture Systems, Inc.
4509 Hickory Creek Lane
Brandon, FL 33511
Toll Free: (800) 994-7599
Phone: (813) 653-2823   ·   Fax: (813) 684-7773

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