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. 

Return To: Larson & Associates Form Page

E-MAIL: sales@filtrationspecialist.com 

I. Contact Information:

Your Name: _________________________ Job Function: ________________________

Company: __________________________ Dept.: ______________________________

Mailing Address: _________________________________________________________

                          _________________________________________________________

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: _____________ pH: _________________

6. Quantity of Material: _____________________________________

7. Type of Application: Batch ______________  Continuous Distillation __________

8. Hours of Operation Per Day: _____________ Per Week:___________________

9. Solid concentration in mg/l or %: __________ 

10. Specify gravity of Solids: __________________________ Liquid: ___________________

11. Can you supply a Material Safety Data Sheet for all of the products being filtered:__________

13. Is any of the material being filtered hazardous in nature: _____________________________

14. Are there any regulatory requirements that must be met: _____________________________

      (Such as FDA certified, ASME code stamped, etc.)  

15. Do you want to recover any of the material being filtered: __________________________

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? (    ) Describe: _______________________________________

IV. Installation - End Results:

A. ____ Remove solids to ____% B. ____ Remove all suspended solids C. ____ Remove color

Filter Efficiency ____% reduction in ____ micron particles

Location: Indoor (    ) Outdoor (    )

Utilities Available: Water (    ) Power (    ) Air (    ) Drain (    ) Floor Space (    ) Height (    )

Do you have any space constraints that must be considered: _____________________ 

O-ring Material: ______ Housing Material: _________

Inlet/Outlet Pipe: Size/Type: _______________ Flanged (    ) N.P.T. (    )