LINING SITE ANALYSIS

Company Name: _________________________________ Date: ____/____/____

Mailing Address: __________________________Shipping Address: ___________________________
City: ________________________ State: _______ Zip: __________ Phone (____) ________________
Fax: (____) __________________ Contact (s): ____________________ Position: _________________
Type of Business: _________________________________Name of Project: _____________________

EXPOSURE CONDITIONS
1.

Lining exposed to? Corrosion: ______ Abrasion: ______ Impact: ______ Other: ______

2.

Chemical (Concentrations and Temperature): ________________________________________

3.

PH Range? From: ____________ To: ___________

4.

Lining subject to live steam? Temp: ______ F ______ C Location of Steam Pipes __________

5.

Is tank pressurized? __________ PSI: _____________

6.

Temperature range? From: _______F ______C (min) To: ______F ______C (max)

7. Thermal Shock? Yes: _______ No: ______

DECRIPTION OF APPLICATION
1.

Dimensions: __________________________________________________________________

2.

Area to be lined: Bottom: _____ sq. ft. Sides: _____ Top: _____ sq. ft. Total: __________sq. ft.

3.

Type of substrate: Concrete: ____ Mild Steel: ____ Stainless Steel: ____Tile: (lined or blocked)_______

4.

Removal? (sq. ft. / thickness) Liner: __________ Coating: ________ Tile: _________ Concrete:
___________ Sealer: ___________ Wood: __________ Other: ____________

5.

Conditions of Surface (% of each) Smooth: ______% Sm. Agg.: ______% Lg. Agg.: ______%

6.

Wall thickness? ____________Flexing? Yes: __________ No: __________

7.

Square: _________ Rectangular: ________ Cylinder: ________ Cone:_______ Other:_______

8.

Age of Tank: ______________

9.

Pitch of fill required (dimensions / thickness) _______________________________________

10. Lining System Recommended: ___________ Primer: ________ Veilcoat: __________

Alternate: _____________ Primer: ____________ Veilcoat: _______________

SITE / APPLICATION CONDITIONS

1.

Access size into tank: ____________________ Other vents: _______________________

2.

Is tank enclosed? Yes: _________ No: _________

3.

Is tank inside? ___________ Outside: ____________

4.

Temperature of area during application and cure (be specific) ___________________________

5.

Work to be done: Weekday: _______ Weekend:_______ Holiday: ______ Shutdown: _______

6.

Total available time for installation and cure (be specific) _____________________________________

7.

Obstructions: Internal (explain) __________________________________________________________

External (explain) _____________________________________________________________________

8.

Is blasting possible? Yes: _____ No: ______ Optional? ___________________________

9.

Compressed air available? (min. 100 cfm @ 90 psi) _________________________________________

10. Electricity? 110V ____ 220V(1ph)____220V(3ph-60amp)______440V(3ph-60amp)_______

11. Lift truck available? Yes______ No: _______
12. Where can debris be disposed of? _________________________________________________________
13. Solvent odor objectionable / ventilation required (explain) _____________________________________
14. Safety requirements? ___________________________________________________________________
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15. General notes: ________________________________________________________________________
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DETAILED DIAGRAM OF AREA TO BE LINED

FOR OFFICE USE ONLY PRODUCT (S)

APPROVED FOR APPLICATION

______________________________

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Customer

______________________________
Authorized Signature

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