Company Contact Title Address City State/Prov.

Country Zip/Postal Telephone Fax E-mail

Response required by

Equipment required by

1. WORKPIECES
New Used	Material	Dimensions	Weight
Description

2. PROCESS
Wash	Rinse	Rust inhibit	Blowoff	Dry
Other, specify
Type & degree of contamination

	Cleaning Criteria		Drying Criteria
	Visually free of contaminants		100% dry
	Detergent residue acceptable		Traces of water that evaporate within minutes
	Isolated traces of contaminants		Droplets falling from part by gravity
	Other		Other

Operation before

Operation after

Process Type
Batch	Continuous	Other

Maximum allowable workpiece temperature during process

On exit of washer

3. PRODUCTION
Rate per hour	Weight per hour	Hours per year

Loading Manual Automatic Description

Unloading Manual Automatic Description

Integration with other equipment? No Yes - Explain

Current cleaning method

Is there a preferred Proceco model? No Yes

Description

4. PLANT / INSTALLATION INFORMATION
Electric (V/ph/Hz)	Gas (psi, Btu/hr)	Steam (psi, lbs/hr)
Water (psi)	Air (psi)	Other
Installation limitations (space, loading door, etc.)
Customer signature (if sent by hard copy)