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Organisation name:

Operating name (if different to above):

Billing account numbe:

Address:

Organisation contacts

Most senior site manager

Organization contact

Name: Name:

Title:
Title:

Phone: Phone:

Email Address: Email Address:

Site activity description:

Water consumption 2005-06 (KL/yr)

Wastewater volume 2005/06 (KL/yr)

List of major water using equipment:

Equipment

Estimated % of water consumed

Cooling tower:

Taps, showers, toilets, urinals

Washdown equipment:

Other (list):

Details of existing water conservation initiatives:
2004/05:

2005/06:

2006/07:

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Organisation name:
Operating name (if different to above):
Billing account numbe:
Address:

Organisation contacts	Most senior site manager	Organization contact
	Name:	Name:
	Title:	Title:
	Phone:	Phone:
	Email Address:	Email Address:

Site activity description:
Water consumption 2005-06 (KL/yr)
Wastewater volume 2005/06 (KL/yr)

List of major water using equipment:	Equipment	Estimated % of water consumed
	Cooling tower:
	Taps, showers, toilets, urinals
	Washdown equipment:
	Other (list):