Survey Form



Company Name:

Your Name:

Your Email:

Your Phone Number:

Boiler Manufacturer:   Year Built:   Size in HP:

Boiler Firing Rate Input MBH/hr:

Burner Manufacturer:   Year Installed:   Model#:

Boiler Serial Number:

Burner Serial Number:

Steam System:   Operating Pressure: lbs.

Hydronic System:

Domestic Hot Water:


Dearator:


Boiler Feed Tank:


Has your load increased or decreased since the system was installed?

Does your boiler use an Economizer:


Does your boiler use a Flue Gas Condenser:


Does your burner use a parallel positioning fuel / air controller:


Does your burner use Natural Gas, Oil? What grade?

Do you have a steam trap and temperature regulator maintenance plan in place:


Do you monitor your combustion efficiency Monthly, Weekly, Other:

What is the gross stack temperature?

What is the ambient temperature in the boiler room?

What is the CO2?

What is the O2?

What is the smoke density number?

What is the boiler plant schedule? Hours per/wk

What days if any do you shut down?: M T W T F S S

What percentage of condensate return water is lost in the process?

How many fresh gallons of make up water per/24hr?

What temperature is the make up water entering the boiler feed unit?

What temperature is your make up water entering your boiler?:

What is your price per therm? including taxes

What is your price per gallon? including taxes

Total yearly fuel consumption Gallons Therms