Please fill this form out as completely as possible to help in a full evaluation of the submission. Please also email attachments to the contact information mentioned at the bottom of the page. Emails submitted without any attachments to support it will be considered incomplete.

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* 1. (Proprietory) Treatment Technology Name

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* 2. Vendor Contact Information

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* 3. What are your objectives for this communication?

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* 4. If this technology destroys PFAS, list what specific compounds it destroys? Please elaborate here and email supporting data to: Nick Swiger at SwigerN@Michigan.gov

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* 5. Do you have documented QA/QC procedures?  If yes, please email the document(s) to: Nick Swiger at SwigerN@Michigan.gov

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* 6. Is your research published in any form (peer reviewed, white paper, etc.)?  If yes, please document(s) email to: Nick Swiger at SwigerN@Michigan.gov

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* 7. What are your funding sources?

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* 8. What assistance are you seeking from the State of Michigan? (contaminated media, PFAS testing data, sites for pilot study, funding, etc.)

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* 9. Remediation Group(s)

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* 10. Remediation Technology

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* 11. Primary Treatment Mechanism(s)

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* 12. Applicable Media

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* 13. Specific Pretreatment Needs

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* 14. PFAS Demonstration Maturity

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* 15. Application Area

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* 16. Which PFAS compounds (including PFAA) demonstrated on?

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* 17. Analytical Method(s) used to detect and quantify PFAS

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* 18. What concentrations of PFAS can it treat? (Min/Max PFAS concentrations, with and without co-contaminants present)

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* 19. List any and all known interferences (includes co-contaminants, natural organics, natural inorganics, solids, etc)

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* 20. Known or expected by-products or any undesired alteration to finished water quality (eg. For drinking water usage, or discharge to the waters of the State or a WWTP etc)

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* 21. Any additional post-treatment requirements before use or disposal of finished water

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* 22. Strengths (Includes treatment of co-contaminants, sustainability, Scalability)

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* 23. Challenges/Limitations (Includes interferences, sustainability, scalability) including those that prevent consistent results

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* 24. Waste Management/Life Cycle

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* 25. Future Data Needs/Gaps

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* 26. Life cycle cost with assessment appropriate for the media and usage

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* 27. Energy consumption assessment

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* 28. Scalability

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* 29. Additional Comments

Please email all supporting documentation and data to: Nick Swiger at SwigerN@Michigan.gov.

When emailing files please use the following file naming convention:
YYYY-MM-DD_ProprietoryTreatmentTechName_DocumentType

Examples of file naming:
2019-10-01_KSpecialCarbon_Publication1
2019-10-01_KSpecialCarbon_QAQC

Any questions related to this form submittal, please contact Nick Swiger at 517-898-6388 or by email at SwigerN@Michigan.gov.

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