Culligan Quench 1010,1030,1070 Technical Site Survey

Culligan Quench 1010,1030,1070 Technical Site Survey
Tools Required:
- iPhone Camera
- Measuring tape
- Thermometer
- Pressure gauge
- TDS meter
- Bucket
- Level
Date Performed

MonthDayYear
Customer Name (The person at the site you are working with or a contact that can answer follow up questions prior to the install.)*
Customer Contact
Customer Phone
Account Number (D-number)
Quench WO #*
Location/Space:
Is the proposed installation site base a solid concrete slab? If No, please provide details.

YesNo
Please provide brief details
Obtain dimensions of desired location for ice bagger installation (Measured in feet) *Instructions: Width, measure from left to right where the unit will be placed; Depth, measure from front to back where the unit will be placed; Height, measure from ground level to the first thing above were the unit will be placed.*
W____ft x D_____ft x H______ft
Is this an outdoor installation space?*

YesNo
What is the ambient air temperature in the installation area?*
°F
Is floor level in the installation space*

YesNo
Take a picture of the proposed unit location from 10 feet back. Picture must include all connections, walls, surfaces, and show any potential obstructions. See example:
Upload Photos*

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Water Source:
Water Source Type*

MunicipalWellOther
Is there a back flow preventer on the water supply line or branch line that will feed the ice bagger? If yes, please take a picture from 1 foot away and attach.*

YesNo
File Upload

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Size of Water Supply Line*

3/8 inch1/2 inch3/4 inch1 inch1-1/4 inchOther
Connection Type*

BarbedCompression (Male)Compression (Female)Flare (Male)Flare (FemaleNPT (Male pipe thread)NPT (Female pipe thread)Press (ProPress or similar)Push-to-Fit (SharkBite, John GuestUnthreaded (Sweat fittingOther
Connection Size*

3/8 inch1/2 inch3/4 inch1 inch1-1/4 inchOther
Is this a dedicated branch line that will only supply the ice machine? If No, please provide brief details*

YesNo
Please provide brief details
Is there a filtration system upstream from the connection for the system? If yes, please provide model(s) of filtration and obtain picture from 2ft away. See photo example:*

YesNo
File Upload

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Water temperature from the water supply after dispensing at least 1 gallon of water.*
° F
Dynamic water pressure of the supply. Connect your pressure gauge and dispense several gallons of water into your bucket. Ensure the pressure does not spike or drop.*
PSIG
Water supply flow rate (Using the stopwatch and calculator apps on your iPhone time how long it takes to fill your 5gal. bucket. Divide the total time by 5 to determine your GPM flowrate.)*
GPM
Take a picture of the water connection from 2 feet away to include both the supply line and connection point. Please see examples below:
File Upload*

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Drain:

Please locate the drain dedicated for ice bagger installation. Take a picture from 2’ away and 10’ away (to show distance from install location). Acceptable drains are floor drains, floor sinks, floor troughs, and low or floor-level mop sinks.
Provide distance from drain to the space dedicated to the new system *
ft
Is this a floor drain?*

YesNoOther
Electrical:

Please take photos (at 1ft) of each outlet required for the specific system. See example below:
1010 System Requirements (2 outlets are required for the unit):

(1) 115V/60Hz/1Ph, outlet on 15 amp circuit(1) 115V/60Hz/1Ph, 3 wire, including ground, NEMA 5-20 Receptacle on dedicated 20 amp circuit
1030 System Requirements (2 outlets are required for the unit):

(1) 115V/60Hz/1Ph outlet on 15 amp circuit(1) 208-230V/60Hz/1Ph, 3 wire, including ground, NEMA 6-20R Receptacle on dedicated 20amp circuit
1070 System Requirements (2 outlets are required for the unit):

(1) 115V/60Hz/1Ph outlet on 15 amp circuit(1) 208-230V/60Hz/1Ph, 4 wire, including ground, NEMA 14-30R Receptacle on dedicated 30 amp circuit
File Upload

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**Note: If there is no floor drain present and a condensate pump must be used to pump to drain, an additional 5-15R (115V/60Hz/1Ph outlet) on a 15 amp circuit will be needed.

Check if an additional 5-15R (115V/60Hz/1Ph outlet) on a 15 amp circuit will be needed
Please add any additional site information that will help in making this a successful install:
*After you submit this form please call the sales engineer on Teams and let them know that you have submitted the form. If they are not available, please leave a message stating that the form was submitted with the customer, time, and date.
Manager Name*
RSD Name*
Technician Name*
Should be Empty: