Company

Contact

Phone

Fax

Date

Street

City

State

Zip

(If prints available, disregard)

A ft/m

B ft/m

C ft/m

D ft/m

E ft/m

F ft/m

G ft/m

H ft/m

I ft/m

J ft/m

K ft/m

Number of discharge feeders:

Number of clogged feeders:

Discharge type:

Slide Gate
Rotary Valve
Vibratory
Other

Feed rate:

TPH

Roof Opening:

Square
Round
Rectangle

" x "

Height of lip on manhole:

ft. in.

Thickness of roof:

ft. in.

INFORMATION NEEDED:

Elevator to the top of the container?

No Yes

Air Slides or other fluidizing equipment?

No Yes

Inverted cones or baffles?

No Yes

Describe

A working dust collection system?

No Yes

Instruments or structural supports inside?

No Yes

Liner or coatings inside container?

No Yes

Obstructions?

Vetical Horizontal
(within 5' any direction inside / outside roof opening)

 

Type of Outlet:

110V 220V 440V

Type of Bottom:

Flat Cone Sloped Other

Air supply available:

PSI CFM

Type of Vessel:

Silo Bin Bunker RailCar Interstice Tank

How long is container available for cleaning?

Safety Training required?

No Yes f/ Hrs

Top of Silo:

Indoors Outdoors

Is roof sloped?

No Yes @ pitch / angle

Roof Load rating?

Last cleaned:

Method used:

Material:

Estimate of non-flowing material:

Planned Storage Capacity:

Last cleaned:

Method used:

Condition of non-flowing material:

Wet Dry

Material Temp:

°F

Moisture %

Compaction:

Soft (Shovel)
Medium (Pick)
Hard (Jackhammer)