Full Name			Title
Address (line 1)			Company
Address (line 2)			Phone
City			Fax
State			email
Zip
Comments

A.    Clearly identify the process that generates the pollutants:

B.    Dust Characteristics:

Granular    Absorbs Moisture    Stringy    Sticky

Free Flowing    Course    Fibrous    Dry    Fine

Particle size range (microns) 

Bulk density  (lb/cu ft.)          

Inlet loading (grains/cu. ft.)     of (lb/min)  

Maximum variation of average inlet loading:

4 minute period    

20 minute period  

C.    Usage:

Hrs/Day     

Days/Year  

D.     Collect representative dust sample (dust entering the filter)

E.    Has another dust collector been applied to the application before? 
        (if yes, provide the following:)

Manufacturer  

Model No.     

Dimensions of filter elements   

No. of filter elements   

Type:    Shaker    Pulse Jet

Media:    Felt Cartridge    Paper Cartridge

              Felt Bags         Woven Bags

Filter Ratio        Typical Pressure Drop   

Filter Life (Mo)    

Mode of Failure:    Rupture    High Emissions    Bleed Through

                           High Pressure    Chemical Attack    Binding 

If pulse collector, type of compressed air dryer:   

F.    Gas Stream

Volume (acfm):         Temperature (Deg/F):     

Gas Constituents:     Air:        

List Other Gases:   

Dew point (^o F)                     Water Vapor   

Free Moisture           Pressure at Collector   

Inlet (if of W.C.)              Oil Mist   

G.    Compressed Air Quality

Type of Dryer       Design Dew Point   

PSIG at Dust Collector       Size of Compressed Air Line

H.    Installation Considerations:

Indoors            Outdoors       

Space Limitations: (i.e. height, available floor space)

Servicing Requirements

Material Discharge Requirements

Drum    Rotary Air Lock    Screw    Dump Valve

Required Hopper Clearance:   

I.    Accessories

Handrails and access ladder   

Service Platform   

Explosion Vents      @  What Vent Ratio? 

Sprinkler Couplings   

Special Pressure Gauge   

Materials of Construction   

Special Finish (Coating)

Outside        Inside   

Other   

Please refer to the Equipment Selection Guidelines for appropriate selection