Centac Fluid

TECHTROL GOLD
FLUID ANALYSIS REQUEST
Fluid Analysis Program Equipment Registration Form

1. Branch or Distributor Information

Distributor: Branch or Distributor Code:
Contact: Address:
City: State: ZIP:
Tel: ( ) Ext: Fax: ( ) Email:

2. Contact Information
End User: City/State/Zip:
Industry: Power Utility Food Processing Manufacturing Pulp & Paper
Hydrocarbon/Refining Mining Other

3. Sample Information
Component: Serial Number (Very
Important)
Manufacturer: Ingersoll-Rand Other (list):
Model:
Sample Point: Separator Tank Crankcase Return Line
Filter Housing Condensate Trap Other:

4. Fluid Information
Fluid to be Tested: Oil Cooling Water Condensate
Fluid Brand Name: SSR Ultracoolant SSR Original SSR H-IF
ROTALUBE 1000 Coolant XL700 XL740HT
Techtrol Gold Techtrol Silver T30
Other
Fluid Filter Make: Filter Size:

Sample Reason: Preventative Maint Warranty Req’t Problem Suspected

Other:
Has this unit been sampled before with the IR Fluid Analysis Program?

PLEASE ENCLOSE THE SAMPLE IN A PLASTIC BAG, AND

TAPE THIS FORM TO THE OUTSIDE OF THE BAG. THANK
YOU.

© Copyright Ingersoll-Rand Company

Date: December 1999 INGERSOLL-RAND
Page 1 of 1
Form TF0008
AIR COMPRESSORS