Company
name:
_______________________________________________________
Name and Title
:
_______________________________________________________
Address
:
________________
________________
Phone
No:
____________________________
Email
:
________________
Fax
No:
________________________________
Customer Id
No:
__________
Is there an elevator
to the top of the container? _________________
1.
Location of container?
Indoor
Outdoor
2.
Is there an elevator
to the top of the container?
Yes
No
3.
Structure
of container:
Steel
Concrete
Other:
__________________________
__________________________
4.
Is there a liner, protective lining or coating inside ?
:
Yes
No
If yes, please describe:
5.
Please provide measurements of the container:
Height
from ground level to top floor:
____________________
Diameter
________
Container height
________
If the container is not round
Width:
_________
Length
_______________
Is there a cone -
Slope degree of the cone: ________________
6.
What is the full capacity
of the container? ________________(tons)
7.1
Which best describes your company's problem?
7.
Please provide number of openings on the top floor, their locations & sizes:
8.
Name
of material or product:
_______________________
9.
Is material toxic?
Yes
No
If yes, please describe:
10.
Is material explosive?
Yes
No
If yes, please describe:
11.
Please indicate the hardness of the build-up and the force required to loosen the material (please check all hardness of material that apply to you) :
Shovel Hard
Pick Hard
Rock Hard
Light Force
Hard Force
Sledgehammer Force
Light Force
Hard Force
Jackhammer Force
12.
How many tons
of material have to be removed?
____________________
(Tons)
13.
What is the discharge capacity?
____________________
( tons per hour)
14.
Number of discharge
values or gates. (Note size and Type):
15.
Are all gates operational?
:
Yes
No
If no, please describe:
16.
Are there instruments or other objects
inside the container besides material ?
Yes
No
If yes, please describe:
17.
What's the distance from the compressor's location
to the container's top?
Length of hose required:
18.
Estimated project date:
__________________________
19.
How many days is the container available for servicing ?
________________________________________
20.
Please provide any additional information you feel we should know: