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| 1.
Line Fluid: |
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| 2.
Line Pressure: |
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| 3.
Line Fluid Temperature: |
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| 4.
Ambient Temperature: |
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| 5.Make/Model
No. of valve now in service: |
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| 6.
Quantity Required: |
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| 7.
Valve Type: |
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| 8.
Pipe Size: |
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| 9.
Orifice Size: |
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| 10.
Flow: |
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| 11.
Maximum Allowable Pressure Drop: |
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| 12.
Body Material: |
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| 13.
Seal Material: |
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| 14.
Operating Voltage: |
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| 15.
Power Consumption: |
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| 16.
Electrical Connection: |
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| 17.
Agency Approval: |
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