Level Application Questionnaire RF CAPACITANCE REFERENCE INFORMATION Customer: ________________________________________________________________________________ Date: Contact Name: _______________________________________________ Phone: _____________________ Email: End User Location: ________________________________________________________________________ FOR OFFICE USE: Tag Number(s): ____________________________________________________________________________ Submitted by: __________________________________________ Rep Agency: ______________________ INSTRUMENT Instrument Function: Transmitter On-Off Control Alarm Model Number: Electronics _________________________ Other ____________________________________ Probe _________________________ Cable ____________________ Quantity: ___________________ PROCESS DATA Process Name/Description: Process Media: Liquid: % Concentration ____________________________ Process Temperature: Process Pressure: Ambient __________ min. __________ max. °F Atmospheric __________ min. __________ max. PSIG Temperature at Instrument: Ambient __________ min. Environment: Corrosive Agency: Normal FM Slurry % Solids ____________________________ CSA Salt Flood Area Classification: ATEX EEx ___________ __________ max. °C Other _______________ Bar °F KPA °C Other _______________ Other _______________ Maximum Viscosity: ____________________ centipoise General Purpose Hazardous Area Design: Hazardous: Class____ Division____ Groups _________ Explosion-proof Intrinsically Safe Non-incendive Other Remote Instrument (if applicable): ______________________________ Required Materials of Construction: Vessel Type: Vertical Cylindrical Horizontal Cylindrical Vessel Size: Height ______________ Type of Filling: Top Liquid Surface: Agitation: Bottom Calm No Width ______________ Other Objects in Vessel: During Filling No Sump/Pit O.C.F. Other Unit of Measure _______________ Side (At what level? __________________________________) Moderate Turbulence Yes Sphere Diameter ______________ Vortex Flowing During Emptying Foam Present: Yes Between Fill and Empty Yes __________________________________________________ No # and Size of Blades ____________ (Include sketch on page 2.) PERFORMANCE What is the maximum_______________ and minimum _______________ level height of the material?: Unit of Measure:_______________ The typical operating level is _______________ Unit of Measure: _______________ Accuracy Required: During filling: _______________% During emptying: _______________% When level is stationary: _______________% When level is stationary and agitated: _______________% RF CAPACITANCE Media Constants: Dielectric Constant: _________ Will Media Coat Probe? No Tank Material of Construction: Span: _______________________ Interface Yes Metal Conductivity: _____ (µ siemen/cm) Solids Lined: Varies? No Yes, from ______ to ______ % Moisture: _________________________ Yes No Coated: Yes No Plastic: Yes No Unit of Measure: _______________________ Dielectric of Second Material: __________ Emulsion Layer: No Yes (If yes, thickness: ______________________) REMARKS BULLETIN: 50-370.0 FOR FACTORY USE ONLY Date Received: Proposal/Order Number: Application Accepted By: Date: Application Forwarded to Engineering for Review By: Date: Application Rejected By: Date: Reason for Rejection: 705 Enterprise Street • Aurora, Illinois 60504-8149 • 630-969-4000 • Fax 630-969-9489 [email protected] • www.magnetrol.com Copyright © 2013 Magnetrol International, Incorporated. All rights reserved. Printed in the USA. BULLETIN: 50-370.0 EFFECTIVE: September 2011