Company Name

Address

Name

Tel

Position

Fax

Email

LIQUID - please give details for all the liquids to be filled with this machine.

A

B

C

Name

Concentration %

Viscosity cP or similar to:-

Specific Gravity

Filling Temperature

Does the liquid foam when filling?

pH (0 to 14)

CONTAINERS - please give details for all the containers to be filled.

1

2

3

4

Capacity litres

Container material of Construction

Container bung size or open top

Has the container
got a vent?

-YesNo

-YesNo

-YesNo

-YesNo

Is the container lined

Yes No-

Yes No-

Yes No-

Yes No-

Lining material

Position of bung

-CentralOffsetRaisedRecessed

-CentralOffsetRaisedRecessed

-CentralOffsetRaisedRecessed

-CentralOffsetRaisedRecessed

Height (mm)

Diameter (mm) /
Width (mm)

Length (mm)

Tare Weight (Kgs)

PRODUCTION REQUIREMENTS

1

2

3

4

Containers to be filled per hr

Containers
filled on

-ConveyorPallet

-ConveyorPallet

-ConveyorPallet

-ConveyorPallet

Filling rate
(litre/min)

Filling rate
(Kgs/min)

If on pallet, multi layer?

-Yes No

-Yes No

-Yes No

-Yes No

No of containers
per pallet

Pallet Length

Pallet Width

Pallet tare weight

Liquid Line, Gravity or pump pressure - bar

Liquid Line
pressure - bar

-0-0.50.5-1.51.5-44-10

-0-0.50.5-1.51.5-44-10

-0-0.50.5-1.51.5-44-10

-0-0.50.5-1.51.5-44-10

Accuracy
required

-0.5%0.5-2%other
If other:

-0.5%0.5-2%other
If other:

-0.5%0.5-2%other
If other:

-0.5%0.5-2%other
If other:

Preferred
measuring
method

-VolumeMassWeightLevel

-VolumeMassWeightLevel

-VolumeMassWeightLevel

-VolumeMassWeightLevel

Do you need
Weight &
Measures
Approval

-Yes No

-Yes No

-Yes No

-Yes No

Do you need
overfill
protection?

-Yes No

-Yes No

-Yes No

-Yes No

Filling Area
Safety
Classification

-Safe AreaZone 1Zone 2Dust HazOther
If other:

-Safe AreaZone 1Zone 2Dust HazOther
If other:

-Safe AreaZone 1Zone 2Dust HazOther
If other:

-Safe AreaZone 1Zone 2Dust HazOther
If other:

If zoned - Distance to nearest safe area if available

SERVICES AVAILABLE

Air Pressure at

> 6bar

> 6bar

> 6bar

> 6bar

Electricity

-110v240v415v

-110v240v415v

-110v240v415v

-110v240v415v

Fume Extract

Other

MATERIALS OF CONSTRUCTION - Type in acceptable parts
Wetted Parts - 316ss / UPVC / PTFE / Nitrile / Vitron / Kalrez
Non Wetted - Painted Steel / Galvanised Steel / Stainless Steel / Aluminium

Wetted Parts

Non Wetted Parts

GENERAL REQUIREMENTS

Are there space limitation?

-Yes No

Other limitations?

Any other comments