Describe Your Application For Engineering Recommendation Submit On-line or Print, Complete and Fax to 805-582-0210 Name Company Address City State Country Zip Code Phone Fax Email Address Line Fluid Line FluidAirWaterHot WaterSteamNatural GasOilOther Gas or Liquid Line Pressure: (a) Inlet (psi) Line_Pressure: (b)Downstream (psi) Line_Pressure: (a-b)Maximum O.P.D. (psi) Line_Pressure: Minimum O.P.D. (psi) Line Fluid Temperature Minimum (°F) Line_Fluid_Temperature Maximum (°F) Ambient Temperature: Minimum (°F) Ambient Temperature: Maximum (°F) Make/Model No. of valve now in service Cost Quantity Frequency FrequencySingle ShipmentAnnually Valve Type Valve Type2-Way3-Way Choose Mode of Operation Choose Mode of OperationNormally ClosedNormally OpenUniversal Pipe Size (NPT) Orifice Size Flow: Cv Flow: GPM Flow: SCFM Maximum Allowable Pressure Drop (psi) Body Material Body MaterialBrassStainless SteelOther If Other, Please Specify Seal Material Seal MaterialBunaVitonEPRTeflonOther If Other, Please Specify Operating Voltage Operating Voltage120VAC/60Hz24VAC/69HzOther If Other, Please Specify Power Consumption (Watts) Electrical Connection Electrical ConnectionDIN (European Spade)Leads Agency Approval Agency ApprovalULCE 15 + 9 = Submit