Belzona Performance Improvement Program for Pumps

Application Survey Form

 

To obtain a detailed Working Specification for your specific pump application, simply complete this form.
Contact Information
Name: End User:
Title: Title:
Company: Company:
Address: Address:
E-Mail E-Mail
Telephone: Telephone:
Fax: Fax:
Equipment Information

Manufacturer / Model:

Time in Service:

Construction (materials / details)

Casing:

Impeller:

Suction Diameter:

Shaft:

Discharge Diameter:

Rings:

Impeller Diameter:

Type of Seal:
   

Bearing Arrangement:
Operating Information
 

Current Status

Original Specifications
Flow Rate:
Flow Speed:
Suction Pressure:
Discharge Pressure:
Power Input:
Efficiency:
Fluid Pumped
Chemical Name:
Concentration (max/min):
Solids Content Temperature
Type: Normal:
Size: Maximum:
Concentration: Minimum:
Symptoms  
Component:
Problem:
Time for damage to become evident:
Suspected Cause:
Repair Options  

Have repairs been carried out previously?
If so, please describe.

Current options under consideration:

Estimated cost of such options:
Timing and Availability  

When will the equipment be available to take out of service?

For how long can it be out of service?

Is the equipment easily accessible?
Is the equipment easily removed for repairs, or should in-place options be considered?

For in-place repairs, what is the working environment? (i.e. access, temperature, humidity, etc.)

Are in-house laborers/mechanics available, or will contractor services be required?

Other Comments: