Larson & Associates, Inc.
Filtration Specialists

Larson & Associates understand that in the field of filtration many demands need to be satisfied.
L&A has constructed this form to better help us understand what your demands are and how we can fill them.
We also realize that not all of the questions will be answered.

I. Contact Information:

Your Name
Job Function
Company
Department
Address
City
State
Zip
Telephone
Fax
E-Mail

II. Project Request form:

Characteristic of fluid to be filtered - Description of Application:

1 Filter Application Air Liquid
2 Flow Rate
3 Temperature:
4 Pressure
5 Viscosity
6 pH
7 Quantity of Material
8 Type of Application Batch Continuous
10 Hours of Operation per Day
11 Days of Operation per Week
12 Solid concentration in mg/l or %
13 Specify Gravity of Solids
14 Specific Gravity of Liquids
15 Can you supply a Material Safety Data Sheet for all of the products being filtered Yes No
16 Is any of the material being filtered hazardous in nature Yes No
17 Are there any regulatory requirements that must be met (Such as FDA certified, ASME code stamped, etc.) Yes No
18 Do you want to recover any of the material being filtered Yes No

III. Do the solids:

1 Stay in suspension?
2 Sink
3 Float
4 Granular
5 Crystalline
6 Hard
7 Gritty
8 Gelatinous
9 Flocculent
10 Soft
11 Slimy
12 Colloidal
13 Other

IV. Installation - End Results:

A Remove solids to
B Remove color

Filter Efficiency reduction to micron particles.

Location: Indoor Outdoor

Utilities Available:

Water
Power
3 Phase 1 Phase
Drain
Air(number CFM and number PSI)
Floor Space
Height

O-ring Material: Housing Material:

Inlet/Outlet Pipe: Size and Type: Flanged N.P.T.