Specification Form 003A

Please fill in all parts of this form. All fields with an '*' are required. If data for a part is unknown, mark "unknown".
This completed form will enable us to recommend the most appropriate and economical valve for your application.

Customer Name*
 Date
Address*
 City/State*
Individual*
 Title
Application
 O.E.M. User
Estimated Quantity Now
 Yearly
Phone*
 Fax
 E-mail
General Specifications

Valve Type Function Electrical Outlet Fluid Connection
Two way
Three way
Four way
Normally open
Normally closed
  Directional Control
  Multi-purpose
1/2" NPT Conduit (C)
1/4" NPT Conduit (C)
Grommet (G)
European DIN connector
Other
1/8" NPT
1/4" NPT
3/8" NPT
Other
Catalog option features (if required)
Explosionproof construction, UL Class I, Groups A,B,C,D; Class II, Groups E, F, and G
Voltage Duty Cycle
AC Max Min
  Cycles
DC Max Min
Continuous duty (energized for more than one hour)
  Time energized hours. Time de-energized hours
Intermittent duty (energized for less than one hour)
  Max. time energized minutes. Min. time de-energized minutes
Orifice Size Cycling Data Life Expectancy
Inlet         Dia, or Cv
Exhaust Dia, or Cv 		Operating speed CPM Total cycles per year
Number of years        
Flow Rate Ambient Conditions
Gases: SCFM @ inlet pressure
  of PSIG and outlet pressure of PSIG
Liquids: GPM @ inlet pressure
  of PSIG and outlet pressure of PSIG
Temperature °F Max.
High humidity and condensation
Other
Pressure or Vacuum Allowable Internal Leakage
Maximum static pressure PSIG
Maximum vacuum inches of Hg
Maximum operation pressure differential PSI
Maximum back pressure PSIG
Minimum operating pressure differential PSI
 None
cc/minute at PSID

Vibration and Shock

Not a factor
Vibration CPS at G's
G's duration for milliseconds
        in Vertical Plane Horizontal Plane

Media Being Handled Approval Required
Description
If gas Lubricated Non lubricated
Temperature °F Max. Min.
Viscosity
  (If over No. 10 SAE oil or 100 SSU at 100°F) 		None
UL listing UL component listing

Other (CSA, FM, etc.)