Name

Company

Address

City

State

Zip

Email Address

Chemical Being Metered

Concentration

Viscosity (CPS)

Specific Gravity

Liquid Temperature (F)

Pressure at Injection Point (psi)

Pump Capacity (GPH)

Are there Solids in the Liquid? Are there Solids in the Liquid? Yes No

If YES: Concentration of Solids

Is Pump Suction Flooded? Is Pump Suction Flooded? Yes No

If NO, Distance to Self Prime

Control Requirements Control Requirements Manually Adjustable Flow Output Only Automatic ON/OFF Control Automatic Proportional Flow Control via Pulse Automatic Proportional Flow Control via 4-20mA

Power Input Power Input 115VAC Single Phase 230VAC Single Phase 230/460VAC Three Phase 12VDC

Installation Location Installation Location Indoors Outdoors

Area Electrical Classification Area Electrical Classification General Industrial Explosion Proof

Accessory Equipment Required Accessory Equipment Required Back Pressure Valve Pulsation Dampener Pressure Relief Valve Calibration Cylinder Corp Stop / Nozzle Assy. Tanks Tank Level Alarms / Control Transfer Pumps Agitator

Other Requirements or Comments