Complete the following form for an Electronic Relief Valve Inquiry. For general company information, complete the company information section so we know how to get in touch with you.

Contact Information Inquiry From Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2001 2002 2003 2004 2005 2006 Telephone ( ) - Fax ( ) - Customer Project Tag# Quantity Bid Due Date Service Conditions Design Pressure Psig Psia Barg Bara kPa MPa Kg/cm² Set Pressure Psig Psia Barg Bara kPa MPa Kg/cm² Reset pressure Psig Psia Barg Bara kPa MPa Kg/cm² Design Temperature ºF ºC K R Operating Temperature ºF ºC K R Capacity Gal/min ft3/hr ft3/s m3/hr l/s Lb/hr Kg/hr Inlet End Connection Butt Weld Ring Type Joint Raised Face Other Outlet End Connection Butt Weld Ring Type Joint Raised Face Other Actuation Description Actuator Type Pneumatic Electric Failure position Open Close Air/Electrical Supply Electrical Requirements Solenoid Solenoid Limit Switch Other Accessories Is an isolation valve required? Yes No Special Instructions: Controls Description Pressure Sensing Unit with Pressure Tube Diaphragm Transducer Local control box with Controller with indicator Terminal Boards Motor starter NEMA 4 enclosure (20"H x 16"W x 12"D) with 2 push buttons, 2 position selector switches and 2 indicator lights Additional Features: Will this be a new installation? Yes No Would this replace another valve? Yes No If yes, Manufacturer and type? Customer Delivery Requirements Quote Due date Estimated Order date