LaGrange Products
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                                                  Request Form


             General Information                                          Type Of Material                      

          Customer Name:                                              Carbon Steel
             Contact Name:                                              Stainless 304
                   Telephone:                                              Stainless 316
                              Fax:                                               2205 Duplex                   
                           Email:                                               2507 Duplex

    Type Of Product                                       Certification Requirements

 Air/Oil Separator                                Paint Pot                                             "U" Stamp
        Air Receiver   Sand Pot: Automatic Closure                                        "UM" Stamp
       Filter Vessel       Sand Pot: Manual Closure                                                      N/C
       Transporters             Surge Bottle/Chamber                                             Canadian Registration
       Oil Reservoir          Other:                                 -  Partial   Complete

Design Requirements                                         Pressure Ratings       

            Customer Supplied Drawings                                                    Minimum PSI:
     Customer Supplied Design Specs                                                   Operating PSI:
      Diameter Of Vessel:                                       Maximum PSI:  
          Height Of Vessel:                          Atmospheric Pressure:  
        Vessel To Contain:  
      Capacity Of Vessel:                                                                         

      Temperature Ratings (F)                                       Finishing Instructions    

Minimum:                                                 Abrasive Blast
        Operating:                                        -  Interior  Exterior
    Maximum:                                                Glass Bead Blast
Atmospheric Temp:                                            -  Interior  Exterior
                                                                                                           Apply Rust Inhibitor
                                                                                                    -  Interior  Exterior
                                                                                             Hot Dip Galvanizing    
                                                                                               Paint Code:

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