CHEMICAL FEED SYSTEM

GENERAL INFORMATION Application Data Sheet	* - Required Information

Customer*:	Click or tap here to enter text.

Phone No.:	Click or tap here to enter text.

Contact Name*:	Click or tap here to enter text.

Email*:	Click or tap here to enter text.

Project Ref.:	Click or tap here to enter text.

ID / Tag Number:	Click or tap here to enter text.

SITE & UTILITY DATA

Installation Location*:	☐ Indoor	☐ Outdoor

☐ Heated	☐ Unheated

Utilities Available*:	☐ Electricity:	Click or tap here to enter text. Voltage / Hertz / Phase

☐ Air:	Click or tap here to enter text. Min / Max Pressure

Ambient Temp:	Click or tap here to enter text. Min.	Click or tap here to enter text. Max.

Electrical Area Class*:	Click or tap here to enter text.

Physical Size Constraints/Dimensional Limitations (if any):	Click or tap here to enter text.

LIQUID DATA Name of Liquid:	Click or tap here to enter text.

Specific Gravity:	Click or tap here to enter text.

Viscosity:	Click or tap here to enter text.

Operating Temp*:	Click or tap here to enter text. Min.	Click or tap here to enter text. Max.

Materials*:	Wetted:	Click or tap here to enter text.

Elastomers:	Click or tap here to enter text. OPERATING CONDITIONS

Flowrate*:	Click or tap here to enter text. Min.	Click or tap here to enter text. Max.

Pressure*:	Click or tap here to enter text. Min.	Click or tap here to enter text. Max.

Service:	☐ Toxic	☐ Flammable	☐ Other Click or tap here to enter text.

PUMP INFORMATION No. of Pumps / Unit*:	Click or tap here to enter text.

Pump Type*:	☐ Diaphragm Metering	☐ Gear	☐ Air Operated Double Diaphragm

☐ Progressive Cavity	☐ Centrifugal	☐ Submersible

☐ Other Click or tap here to enter text.

Pump Controls*:	Stroke Adjustment:	☐ Manual	☐ Automatic

Control Signal:	☐ Pneumatic	☐ Electronic

Applicable Specs:	☐ API 675 Positive Displacement Pumps – Controlled Volume

☐ API 676 Positive Displacement Pumps – Rotary

☐ API 610 Centrifugal Pumps for Petroleum, Petrochemical and Gas Industries

☒ Other Click or tap here to enter text.

PIPING, INSTRUMENATION & ACCESSORIES Process Piping:	☐ Piping	☐ Tubing	☐ Other Click or tap here to enter text.

Piping Type:	☐ Threaded	☐ Butt Weld	☐ Socket Weld ☐ Compression Fittings

☐ Other Click or tap here to enter text.

Instrumentation*:	☐ Pressure Relief Valve	☐ Back Pressure Valve	☐ Pulsation Dampener

☐ Pressure Gauge	☐ Pressure Transmitter	☐ Flow Meter

☐ Calibration Column	☐ Suction Strainer	☐ Local Control Panel

☐ Other Click or tap here to enter text.

Common Frame for Mounting All Components*:	☐ Yes	☐ No INSPECTION & TESTING

Standard Testing:	☐ Visual	☐ Electrical Continuity	☐ Hydrostatic	☐ Functional

Documentation:	☐ Material Certificates (MTRs)	☐ Instrument Calibration Certificates

Non-Destructive:	☐ Positive Material Identification	☐ Radiography	☐ Liquid Penetrant	☐ Ultrasonic Thickness	☐ Hardness	☐ Magnetic Particle

☐ Other Click or tap here to enter text. PACKAGING

Shipment Preparation:	☐ Domestic	☐ Export

ADDITIONAL INFORMATION

SYSTEM SKETCH or P&ID