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Emergency Shut-off Valves Questionnaire

Please complete the following questionnaire so that we may better understand your requirements and specifications. (*) Indicates required fields.

Name: *

Company: *

Organization:

Email: *

Phone: *

Fax:

Street:

City:

State:

Zip Code:

Project:

Project Location:

Application:
Chlorine    Sulfur Dioxide

Will the vacuum regulator(s) be mounted on the 150lb cylinder(s) or ton container(s)?
Yes    No

Is Emergency Shut off Valve actuator to be mounted to a
150Lb Cylinder    Ton Container

Will the Emergency Shut-off Valve actuator only be required to close by:
Remote control    Leak detector    Panic button    or other digital signals such as PLC computer

How many actuators will be required at each location?

Electrical:
pH Volts

Additional Comments: