If you have a specific cleaning related problem, please complete the form below so we can direct your questions to the appropriate application specialist:

Items in red are required.

Consultation Code

(if applicable)

Contact Information

Name

Title

Company

Address 1

Address 2

City

Region/Province/State

Postal/ZIP Code

Country

Phone

Fax:

Confirm Email:

Web:

Your principal activity:

If 'Other', please describe:

What size/how often do you purchase high-quality cleaners?

units (single boxes or bottles)	Frequency:
cases (of boxes or bottles)	Frequency:
medium sizes (50-100 lb or 5-15 gal drum)	Frequency:
bulk sizes (300 lb or 55 gal drum)	Frequency:

Your primary job function:

If 'Other', please describe:

Estimated annual purchases of high-quality cleaners, if known

(in US $):

What are you cleaning?

What surfaces are you cleaning?	Polycarbonate, acrylic, and other sensitive plastics Filters, membranes, RO or UF systems PC boards, wafers, electronic components Pipets in syphon washers Soft metals: aluminum, copper, brass, other non-ferrous Stainless steel, iron, nickel Glass, ceramic, porcelain, rubber, fiberglass, plastic Other
If 'Other', please describe:

What soils are you removing?

Proteinaceous soils, blood and other body fluids, tissue
Inorganic soils, scale, salts, metallic complexes, metal oxides, trace metals
Silicone oils, mold-release agents, buffing compounds, radioisotopes, radioactive contaminants
Oils, cutting fluids, chemical, solvents, bio-residues, particulates, laboratory soils
Heavy oils, greases, baked-on residues
Conductive residues, resins, rosins, solder, fluxes, particulates, salts
Other

If 'Other', please describe:

What do you use the cleaner for?	Floor, walls, cookware Labware Field sampling equipment Other re-usable items/instruments Filtration Membranes Large manufacturing equipment Manufactured Items Selling/Distribution Other
If 'Other', please describe:

How are you cleaning?

What type of cleaner do you use?

Liquid cleaner
Powder cleaner
Not sure

If you clean by immersion, how?

Method	Brand	Age (yrs)
By Hand
Soak or circulate clean-in-place
Syphon pipet washer
Power spray wand
Ultrasonic
Other Non-spray

What machine cleaner do you use?

Type	Brand	Age (yrs)
Glassware washer
PC board washer
CIP spray
Parts washer
Washer/sanitizer
Power spray wand
Solvent vapor/soak
Other

Is there an acid rinse cycle?

How long is the cleaning cycle?

How are you rinsing?

What rinsing method do you use?

No rinse
Wipe rinse
Dip tank(s)	How many tanks?
Overflow dip tank(s)	How many tanks?
Running water rinse	How long?
Other method	Please describe:

What temperature rinse?

What kind of rinse solution are you using?

Tap water
Softened water
Distilled water
Deionized
Ultra-filtered (UF)
Reverse Osmosis
Solvent solution	(specify type)
Other	(please describe)

How are you drying?

What kind of drying are you using?

Air dry
Forced air dry
Open dry
Vacuum dry
Drying solvent	(specify type)
Other	(please describe)

Cleaners

What concentration of cleaner do you use?

If 'Other', please specify:

What cleaners are you currently using?	Alconox Liquinox Tergazyme Alcojet Luminox Citranox Citrajet Alcotabs Detojet Detergent 8 Solujet Tergajet Other
If 'Other', please describe:

How is cleanliness determined?	Visual Ionic contamination Ultraviolet light Water drop test Surface analysis Other
If 'Other', please describe:

Issues, Comments, Concerns

Are you are currently experiencing problems with the cleaner you are using?

Any special waste treatment/disposal concerns?

Is rusting an issue?

Enter the words as they appear.

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		Alconox, Liquinox, Tergazyme, Alcojet, Alcotabs, Detojet, Detergent 8, Citranox, Luminox, Citrajet, Solujet, and Tergajet are ® Registered Trademarks of Alconox, Inc. Copyright © 2009 Alconox, Inc. All Rights Reserved \| Site Map