Facility Name: Installed Location:

Operating Conditions (at installation):

• Liquid Data:
  • Liquid Description:
  • Temperature:
  • Specific Gravity:
  • Viscosity (cp):
  • pH:
  • Ambient Temperature:
  • Solid Size & Content:
• Capacity: GPM
• Suction Pressure: PSI
• Discharge Pressure: PSI
• Head Pressure (TDH):
• Speed: RPM
• Pump Mounted: (Inside or Outside)

Pump Data:

• Manufacturer:
• Model:
• Serial Number:
• Pump Size:
  • Discharge Diameter:
  • Inlet Diameter:
  • Case Size:
• Impeller Diameter:
• Shaft Size:

Sealing Data:

• Packing or Mechanical Seal:
• Mechanical Seal Information:
  • Single Seal or Double Seal:
  • Component or Cartridge:
  • Seal Manufacturer:
  • Face Materials:
  • O Ring Compound:
  • Flush: Yes / No

Material of Construction:

• Case Material:
• Impeller Material:

Motor Data:

• Horsepower:
• Speed: RPM
• Voltage:
• Frame:
• Enclosure:
• Service Factor:
• Motor Shaft Size:
• Full Load Amps:
• Amp Reading (Under Load):
• Amp Reading (No Load):
• Manufacturer:

Drive Data:

• Drive or Belt Drive:
• Coupling:
• Coupling Information:
  • Coupling Brand:
  • Coupling Model:
  • Coupling Size:
  • Insert Material:

Comments: Area Address: