Application Data Form

Before a quotation can be issued, we should have this form completed.
Company Name
Contact Name
Street or PO Box			Zip Code
City			Phone
State/Province			Fax
Date
eMail
PROCESS SPECIFICATIONS
Product	Slurry NonSlurry	Process Material
Density Range	to		Unit:
Accuracy	% of span
Accuracy	G/L
Normal Product Temperature	degrees C
Temperature Range	to degrees C/F
Ambient Temperature	degrees C
Solution		Slurries
Density Solvent		Carrier Density
Solute Density		Solids Density
Physical Arrangement
Nominal Pipe Diameter	inches
Schedule
Inside Diameter	mm
Outside Diameter	mm
1st wall thickness	mm	Material
2nd wall thickness	mm	Material
Insulation Thickness	mm	Material
Liner Thickness	mm	Material
Hazardous area classification
HART communication required? Yes No
RETROFIT If this is a retrofit where an existing source will be used, we will need to know:
Size of existing source (mCi)
Isotope of existing source			(Cs 137, Co60, etc)
Original Date of Source
Source Supplier