Electric Design Specs

Customer Name :

Date :

Contact :

Position :

Phone No. :

Fax No. :

Email :

Application :

Pressure (PSI) :

Volume (GPM) :

Replacing Existing System :

Specify Make/Model :

Operating environment :

Hazardous Location : Yes No

Corrosive Environment : Yes No

Desired Drive System :

Electric Driven

Gasoline Driven

Air Driven

Desired Mounting System :

Portable

Stationary

Special Mounting Base

Automatic Start/Stop Control Yes No

Desired Heater Type :

Electronically Heated

Natural Gas

Propane

Diesel

Electrical Available :

Voltage :

Phase :

Hertz :

Amperage :

Hour Meter(s) : Yes No

Type of Fluid Being Pumped : Water Other (specify) :

Type of Inlet Conditions:

Municipal Water Feed

Well Feed

Tank Feed

Closed Loop System

*Specify Amount of Suspended Solids

Microns

Inlet Water Temperature:

Temperature :

C

F

Other Conditions:

High Inlet Water Temperature Protection Yes No

Low Inlet Water Pressure Protection Yes No

Desired Chemical Injection System :

Upstream (High Pressure)

Downstream (Low Pressure)

Remote Chemical Station

None

Other (specify)

Type of Chemical Being Injected :

WHMIS/Chemical Data Sheet Available : Yes No

Type of Discharge Conditions :

Single Gun

Multi-Gun

Other (specify)

Length of Discharge Piping:

FT

Number of Active Guns :

Pulsation Damper : Yes

Gauge : Yes

Standard Hose/Gun/Wand with Unit : Yes No

Extra : Hose Gun Wand Nozzle (specify)

Additional Information :

Customer Application Design Specifications

Please fill in this form as completely as possible to ensure we can address all your specific needs.