Fuller Weighing - Liquid Filling Application Form

Eliminate the Guesswork with the
Maximum in Control and Reliability

Company Name	Phone	Fax

Address	City	State	Zip

Person to Contact	Title	E-mail

Product Information:

Product name: Foaming? Yes No

Specific gravity: Viscosity (Centapoise):

Temperature: Fahrenheit Celsius

Electrical classification: Class: Division: Group:

A.I.T.: Fahrenheit Celsius

Working pressure at the filler: PSI (BARS) Flow Rate: GPM (KGM)

Is the material toxic or caustic: Yes No (If yes, please send OSHA form)

Is the material for human consumption and requires 3A or FDA specifications: Yes No

Is the material corrosive: Yes No

If yes, what material is recommended for the wetted parts:

Standard construction includes 316SS stainless steel piping with Teflon seals for all wetted parts.
All structural parts, controller, and scale base are made of mild steel, painted Fuller blue epoxy.

Provide any information as to special characteristics of materials
(i.e. explosive, hardens, carcinogenic):

Requested cycle time: minutes

Requested fill tolerance +/- : lb/(kg)*
* Normal System Fill Accuracy: +/- 3 increments on a 3 sigma basis

Drum Filler Location Requirements:

Electrical power available: VAC, HZ

Is compressed air available? Yes No

Is air pressure less than 90PSI (6 BARS)? Yes No

Is an air dryer in use? Yes No

Is a recirculating line used with the pump? Yes No

Is the ambient temperature less than 32 degrees F (0 degrees C)? Yes No

Is the ambient temperature greater than 104 degrees F (40 degrees C)? Yes No

Is the area a corrosive or washdown area? Yes No

Materials required for the scale base? Mild Steel Stainless Steel

Is this system using a gravity or powered conveyor? Yes No

If yes, give height of conveyor?

What is the maximum ceiling height where the drum filler will be located?

Container Information Data:
Containers to be filled on the drum filler (check all that apply): Pails Drums Totes Are pallets being used under the containers? Yes No If yes, enter the size of the pallet: long X wide X high

Enter the sizes and construction of all the containers being filled in the chart below. If the containers are reconditioned or special, enter the custom specifications. See diagram below for alphabetical designations.

Drum/Pail	1	2	3
Size (gal)
Open top?
Material
Bung Size
A
B
C

Tote	1	2	3
Size (gal)
Open top?
Material
Bung Size
D
E
F
G
H
I
J
K
L