Please print this form, complete, and fax it to Tomtec at (203) 248-5724 with your company Purchase Order Form. Thank you.
If you have any questions or need assistance filling out this form please contact a Tomtec Customer Service Representative. PDF Version
384 Well Custom Reservoir Form
Date:
PO #:
Bill To:



Ship To:



Phone:
Fax:
Catalog Number: 384-130-XX
Quantity:
Date Required:
Specifications for the CUSTOM 384 Reservoirs
Outer Height: 1.125 inches
Inside Depth: 0.430 inches
Type of Bottom (please check one): Flat
Dimpled
Please mark the diagram below, outlining the footprint for the customized reservoir. For best results use a thinline black
felt tip marker. Note: Custom design may be limited due to well spacing. Submit design for manufacturing confirmation.