CHLORINE DEMAND INFORMATION SHEE

CHLORINE DEMAND INFORMATION SHEET
(Please Print this Page & include it with your sample)

Follow the water sampling instructions at the end of this
form for accurate results.

Name  _________________________________________   Tel (H) ________________

Address ________________________________________ Tel (W)________________

City  ______________________________   State ______ Zip/Postal _____________

E-Mail __________________________________________    Current Water Temperature_________

Pool Type: Inground____ Aboveground____ Surface (concrete, vinyl, etc):_____________

Pool Size (dimensions)_____________ Gallons__________________ Shallow Depth________ Deep Depth________

Water Features (fountains, attached spa, waterfall, etc., please describe):________________________________________

______________________________________________________________________________________________________

Type of Sanitizing system you use in your pool (chlorine, bromine):________________ OR Salt Generating System_____

Are you utilizing a Pool Care Program in your regular treatment: Yes___ No____

If Yes, which system (BioGuard 3 step, Sustain, etc):__________________________

When was the pool lasted shocked?______________________________________

When was the pool opened?____________________________________________

Filter Type (Sand, DE or Cartridge):_______________ Date that the Filter was last chemically cleaned:___________________

Filter Run Time:________ Hours per ________, _____Days per _______ Does your pool have a bottom main drain?_______

Is your pool (check all that apply): Cloudy____ Algae_____ Clear_____ If your pool is cloudy, How cloudy is it? Select one:

Hazy (you can see the bottom)____ Cloudy (see about 1/2 way down) ____ or Doesn't seem to sparkle____

How much usage does the pool get? Everyday____ Couple of times per week____ Infrequent_____ Almost none____

There's always a party going on_____

Do you add a maintenance algicide: Daily___ Weekly____ Monthly____ Only when told to_____ When it turns green____

My pool is in the full sun ________ Hours per day. Pet uses Pool: Yes ___ No ___

Our pool is filled with: Well Water______ Municipal Water______

Other Pool issues we should know about in order to better help you? Please provide details:

_________________________________________________________________________________________________________

Tell us about the pool environment (trees, shrubs, lawn servicing, neighbors yard, pets, nearby farms, birds, rainy weather, etc.,
nothing will sound silly):

_________________________________________________________________________________________________________

Method of Payment:
Call me for my Credit Card ___ $15.00 Chlorine Demand Test & Analysis Fee ($10.00 may be used for future purchases).
Testing & Analysis will not be performed without payment information.

Here's my Credit Card information:

Card #________________________________ Exp ________

Signature__________________________________

Water Sample Instructions ONE QUART OF WATER IS REQUIRED:

Be sure that the filter has been running & the pool water circulating for at least 6 hours prior to taking the
water sample.
Use a clean, plastic container ONE QUART water sample (must be sent in a clean, plastic bottle that was
NOT used to hold cleaning fluids, soda, food in general - an empty water bottle is best).
Rinse the bottle with the POOL WATER 3 times.
Turn the bottle upside down & take the sample from AT LEAST 15 TO 18 INCHES DOWN.
At the proper depth, turn the bottle upright to fill the bottle completely. ONLY FILL WITH WATER THAT HAS
BEEN TAKEN FROM THE PROPER DEPTH OR AN ACCURATE ANALYSIS WILL NOT BE AVAILABLE.
Put the bottle cap on tightly & seal it with tape & place it in a Zip type bag before properly boxing & sending
the sample.
Be sure to enclose a completed copy of this Information sheet.
Send the Water Sample via OVERNIGHT FedEx, DHL, UPS, etc. The sample must be "fresh" (no older than 2 days
for the most accurate results.)

Par Pool & Spa will do a complete analysis of the water. This includes Free Chlorine, Total Chlorine, Combined Chlorine,
pH, Total Alkalinity, Calcium Hardness, TDS, Mineral Level, Iron, Copper, QUAT, Chlorine Demand, Saturation Index

We will contact via telephone & email about the recommendations for your pool.

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