Application Data Form

Application Data Form/Point Level Switch

Before a quotation can be issued, we must have this form completed.
Company Name
Contact Name
Street or PO Box			Zip Code
City			Phone
State/Province			Fax
Date
eMail
PROCESS SPECIFICATIONS
Product	Liquid Solid
Product density	g/I
Operating Pressure	PSI
Normal product temperature	degrees C/F
Ambient temperature	degrees C/F
High alarm or low alarm
POINT LEVEL INTERFACE
Density Product 1		Gas density
Density Product2		Foam density
PHYSICAL ARRANGEMENT
Vertical vessel or horizontal vessel
Vessel inside diameter	mm/inches
Wall thickness-steel	mm/inches
Wall liner	mm/inches		Material
Wall heat/ cool jacket	mm/inches		Material
Insulation thickness	mm/inches		Material
Other wall thickness	mm/inches		Material
Agitator? Yes / No	If yes, diameter of shaft:
Hazardous Area Classification

Eccentric path-distance from center of vessel in mm/inch
Response time of level switch	seconds
Explosion proof environment?	Yes / No
Other radiation gauges near this level switch Yes / No (If yes, provide a sketch to berthold-us@bertholdtech.com)
Other important vessel information:

Required delivery time
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