Assemblies
310
S.T.A.M.P.E.D. Form
Size
ID
OD
Hose Length (OAL or uncpld. lgth.)
Tolerances
Temperature
of Material Being Conveyed
(
high, low, ambient)
of Outside Exposure (high, low, ambient)
Intermittent?
Constant?
Sub-Zero Exposure
Application(s)
Indoor and/or Outdoor Use
Intermittent or Continuous Use
Flexibility Required (min. bend radius)
Movement (static, vibrations, flexing)
External Conditions:
Abrasion
Oil
Solvents
Acid
Ozone
Electrical/Static Conductive
Oil Resistance:
Tube
Cover
Flame Resistance
Noncontaminating Materials
Hose Currently in Use
Current Hose Service Life/Failure Description
Service Life Desired
Material(s) Being Conveyed
Solids (size, description)
Gaseous (volatility, inert)
Liquids (flammability, causticity, acid, alkaline,
solution/concentration)
Chemical Names (generic)
Pressures(s)
Working Pressure (including surges)
Burst Pressure
Suction or Vacuum Requirements
Velocity
Impulse
Ends & Fittings
Type of Threads
Male/Female
Reusable/Nonreusable
Material for Fittings
Swivel or Non-Swivel
Straight or Bent Tube
Fitting 1 & 2 Orientation
Other
Cut to Length
Crimp Specs or Crimper Used
Delivery
Lead Time
Quantity
Stock/Nonstock
Special Print
Special Packaging
Other Information
Customer:
Date:
Customer No:
Ship To:
Bill To:
Telephone:
Fax:
Bolded block areas MUST be filled out on all inquiries.
Appendix
Installation & Maintenance
Assemblies
Equipment & Accessories
Fittings
Hoses