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Gasket Application Data Form
Date____________________________________ From ___________________________________
For: Garlock Gasketing Engineering Title ____________________________________
Fax 315-597-3290 Company________________________________
Page: 1 of _______________________________ Address _________________________________
Drawing attached ❑ Yes ❑ No City / State / Zip___________________________
Phone __________________________________
Fax ____________________________________
E-mail __________________________________
Application
❑ Pipe Flange ❑ Pumps – centrifugal / horizontal split case
❑ Heat Exchanger ❑ Flue Duct
❑ Manway ❑ Valve Bonnet
❑ Compressor ❑ Other ________________________________
Service Conditions
Maximum Temperature ________________ °F/ °C Continuous Operating Temperature ______ °F/ °C
Internal Pressure ___________________psig / bar PSIG / bar ❑ Continuous ❑ Intermittent
Thermal Cycling___________________/ 24 hours Vibration ❑ Yes ❑ No
Other (specify) _______________________________________________________________________
Bolts
Grade___________________________________ Diameter ________________________________
Length __________________________________ Number _________________________________
Chemical Compatibility
Media___________________________________ pH _____________________________________
Concentration ____________________________ Liquid or Gas_____________________________
Flange
Standard Non-Standard
Material _________________________________ Material _________________________________
Size ______________ Rating_____________ I.D. / O.D. ________________________________
Surface Finish ________________________RMS Flange Thickness _________________________
❑ Phonographic ❑ Concentric Bolt Circle Diameter _______________________
Face (raised, flat, tongue & groove, etc.) _______ Surface Finish ________________________RMS
________________________________________ ❑ Phonographic ❑ Concentric
Face (raised, flat, tongue & groove, etc.) _______
_______________________________________
Comments: _________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Questions? Call Gasket Applications Engineering at 1-800-448-6688
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