Boiler Water System Evaluation
Form
 
  
Date:______________________________ 
Client's Name: 
 
Address: 
 
  
Telephone:________________________ 
Fax:______________________________ 
E-mail:____________________________ 
Representative: 
 
Send Reports to: 
 
Send copies to: 
 
| Boiler Number | 
Make of Boiler  | 
Water tube or Fire Tube  | 
Horse Power or pounds of Steam/Hour 
Max/Actual  | 
Hours Operated/Day 
Winter/Summer   | 
Fuel Type used  | 
Stoker or Burner Type Used  | 
Main Fireside Problem  |  
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Days of operation/week:  
  - Summer____ 
  
- Winter____ 
  
- Steam Pressure:_____psi 
  
- Fire Box Temp:____ Degrees F Degrees C
     
Average Daily Fuel Consumption: Summer____
Winter____ 
Can Stack Damper Be Closed? Yes No 
How is soot and fire scale removed? 
 
Frequency of Removal:__________________________ 
Preconditions: 
 
Oil storage tank capacity:_________________________US gal Liters  
Number of tanks:_____________ 
Condition of oil system: 
 
Oil preheat temperature:_______________________ Degrees F
Degrees C 
Source of makeup water for boiler: City Well River Other (Specify)___________________ 
Is softened water used for boiler make-up? No Yes - type:
Zeolite
Demineralized
Cold
lime-soda Hot lime-soda Other  
 
Boiler water treatment is added by this method (check all that apply) Directly to the
boiler Injector Bypass feeder From makeup tank From return condensate tank
Chemical
Pump Other (specify) 
 
Boiler blowdown schedule: ______ A.M. ______ P.M. 
How often is boiler washed?_______________________________________ 
Heater type: (check all that apply) Open Closed Vented Dearating None 
Length of feed line from point treatment is added to the
boiler:_____________ feet meters 
Condition of feed line:______________________________ 
Are any of these problems present in the boiler-water?
Foam
Prime
Surge 
Summary of boiler inspectors report: 
 
  
Present condition of water side of boiler: (check all that apply) Scaled Corroded
Pitted
 
Other (describe) 
 
State all purposes for which steam is used. Please be specific.
For instance, "processing" would be too generic as a description. 
 
  
How will the sample of return condensate be taken? 
 
How and where will any of the Alken Treatment-J
series be introduced? 
 
Present condition of steam lines: 
 
Where is steam lost?_______________________________________ 
Treatments currently in use (product names and dosages): 
 
 
  
Does engineer have boiler water testing equipment? No Yes - Manufacturers,
models, & tests covered): 
 
  
This survey was conducted for the following reasons: Proposal
Letter
Lab
records Other  
 
Incoming (Make-up) Untreated Water 
|  Analysis | 
 Survey Results | 
 Variation | 
 Analysis | 
 Survey Results | 
 Variation |  
|  Source | 
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 NaCl | 
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|  "P" Alkalinity | 
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 TDS | 
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|  "M" Alkalinity | 
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 Fe | 
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|  Calcium Hardness | 
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 SiO2 | 
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|  Total Hardness | 
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 pH | 
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| Boiler System (Feedwater)  | 
 Steam Characteristics  |  
 
 
|   Analysis | 
Survey Results | 
 Variation | 
 Observation | 
 Survey Results | 
 Variation |  
|  "P" Alkalinity | 
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 psig | 
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|  "M" Alkalinity | 
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 Temp: Steam | 
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|  Total (Acid) Hardness | 
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  Water | 
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|  NaCl | 
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 Oxygen: Rated | 
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| TDS | 
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 Actual | 
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|  % Make-up | 
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 Load: (lb/day) | 
 Summer | 
 Winter |  
 
 
Condensate Characteristics
|  Analysis | 
 Survey Results | 
 Variation |  
|  Hardness | 
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|  pH | 
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|  Iron (total or insoluble) | 
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|  TDS/Conductivity | 
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|  % Return | 
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|  Temperature | 
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Boiler Water Controls
|  Analysis | 
 Survey Results | 
 Recommended Levels |  
|  "P" Alkalinity | 
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|  "M" Alkalinity | 
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|  "OH" Alkalinity | 
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|  PO4 or Chelate Residual | 
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|  NaCl | 
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|  TDS | 
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|  Other (Fe, Si, Oil, etc.) | 
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Testing Frequency (check ONE) shift daily weekly monthly none  |