SEALANT RECOMMENDATION REQUEST FORM

NAME:

COMPANY:

EMAIL:

DATE:

DATE/TIME RECOMMENDATION NEEDED BY (ASAP, NEXT DAY, TWO DAYS):

SERVICE/APPLICATION DESCRIPTION:

PROCESS/PRODUCT STREAM AND PERCENTAGES % IF AVAILABLE:

ALSO COMMON NAME IF AVAILABLE:

OPERATING & SKIN TEMPERATURE AT POINT OF LEAK:

OPERATING PRESSURE:

IS PSI CONSTANT:
Yes No

WHAT TYPE OF LEAK (FLG. WELD, VALVE BONNETT,PACKING,ETC):

DESCRIBE GAP OR VOID AREA FOR SEALANT (SIZE/VOLUME):

RATE THE SEVERITY OF THE LEAK FROM (1 TO 10 OR WHISPER TO HURRICANE):

LENGTH OF TIME NEEDED FOR THE TEMPORARY FIX:

ADDITIONAL INFORMATION REVELANT TO RECOMMENDATION REQUEST:

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SOUTH COAST PRODUCTS/PDL SEALANT RECOMMENDATION:

DISCLAIMER – RECOMMENDATIONS ARE BASED SOLEY ON INFORMATION PROVIDED. OMISSION OF PERTINENT INFORMATION, MISHANDLING OR MISAPPLICATION OF SEALANT, OR CHANGES OCCURING IN THE FIELD CAN AFFECT THE SELECTION OF THE PROPER SEALANT AND ARE NOT THE RESPONSIBILITY OF SOUTH COAST PRODUCTS/PDL.

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SEALANT RECOMMENDATION REQUEST FORM

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