FS01082019

APPLICATION DATA SHEET

I. CUSTOMER INFORMATION
PRINT SUBMIT
Company: ____________________________________________________ Date: __________________________
Contact: ____________________________________________________ Ph: __________________________
Title: ____________________________________________________ Ext: __________________________
Address: ____________________________________________________ E-m: __________________________
City, St, Zip:____________________________________________________ Fax: __________________________

II. VESSEL INFORMATION

1. Vessel ID: ____________________

Roof Openings
(if prints are available, disregard)
I
A: _______________ ft H
B: _______________ ft
C: _______________ ft
D: _______________ ft
J H: _______________ ft
E: _______________ ft
I: _______________ ft
F: _______________ ft
J: _______________ ft
G: _______________ ft K
(access door if any) K: _______________ ft

2. Number of Discharge Feeders: ______ 3. Number of Clogged Feeders: ______

4. Discharge Type(s): Slide Gate Rotary Valve Vibratory Other 5. Feed Rate: ______ TPH

6. Roof Opening(s): Square Rectangle Round _______" X _______" ________ " Dia

7. Height of Lip on Manhole: ________ ft _______ in 8. Roof Thickness: ________ ft _______ in

9. A working dust collection system? Yes No

10. Instruments or structural supports inside? Yes No

11. Liner or coatings inside Vessel? Yes No

12. Elevator to top of the Vessel? Yes No

13. Top opening into Vessel (min. 18"x18")? Yes No

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 FS01082019

APPLICATION DATA SHEET

II. VESSEL INFORMATION

14. Inverted cones or baffles? Yes No Describe: _________________________________________

15. Air Slides or fluidizing equipment? Yes No

16. Obstructions w/in 5' any direction inside or outside of Roof Opening? Vertical Horizontal None

17. Type of Vessel: Silo Bin Bunker Railcar Tank

18. Type of bottom: Flat Cone Sloped Other

19. How long is Vessel available for cleaning? _________ Days __________ Hours

20. Safety training required? NO YES f/_____ hrs 21. Roof Load Rating? ________________________

22. Top of Vessel: Indoors Outdoors 23. Electric Available: 110V 220V 440V
24. Is Roof sloped? NO YES @_______ pitch / angle 25. Air Supply Available: PSI: ______ CFM: ______
Quote Portable Compressor Rental
II. MATERIAL INFORMATION

“ ” Type of problem; If other, indicate on 5

1 2 3 4 5

ARCHING BRIDGING CLINGING PIPING (SKETCH) ________________

1. Material: ___________________________________ 5. Condition of Non-Flowing Material: Wet Dry

2. Estimate of Non-Flowing Material: ______TONS 6. Material Temp: _________°F Moisture %: _________
3. Planned Storage Capacity: _____________ TONS 7. Compaction Level:
4. How Will Dislodged Material Be Removed: Soft (Shovel) Medium (Pick) Hard (Jackhammer)
_______________________________________________
8. Last Cleaned: __________________________________
_______________________________________________
9. Method Used: __________________________________
_______________________________________________
_________________________________
_______________________________________________

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airmatic.com | 215.333.5600 | infocenter@airmatic.com