CEMS Request Form

Please fill out as completely as possible.

Use “N/A” or leave blank if an item does not apply to your application.

REQUESTOR'S INFORMATION

Contact Name:

Company:

Address:

Phone:

E-Mail:

Length of rental period:

Requested installation date for CEMS:

How did you hear about us?:

PLANT INFORMATION

Plant Name:

Location:

Phone:

FAX:

E-Mail:

Other pertinent plant information:

PROCESS INFORMATION

Type of Process:

If Other, please specify:

Flue Gas Temp:

Flue Gas Velocity:

Flue Gas Volumetric Flow Rate:

Particulate Loading:

H2O Content of Effluent:

O2 Content of Effluent:

CO2 Content of Effluent:

Pollutant Contents of Effluent

(list all expected pollutants and estimated concentrations):

NOX Concentration:

SO2 Concentration:

CO Concentration:

THC Concentration:

CH4 Concentration:

HCl Concentration:

H2S Concentration:

NH3 Concentration:

SAMPLING LOCATION

Stack or Duct Type:

Stack Height:

Stack Diameter (or dimensions):

Sample Port Height Above Ground:

Sample Port Flange Size:

Sample Location Accessible by:

CEMS INFORMATION

Number of CEMS Required:

Stream Switching Acceptable for Multiple Sampling Locations:

Length of Heated Sample Transport Lines:

System Hardware Location:

Area Classification at System Location:

Ambient Conditions at System Location:

Line Power Available at System Location:

Analyzer Manufacturer Preference:

Desired Pollutants to Monitor:

Desired Diluents to Monitor:

Additional Process Parameters to Monitor:

Additional Comments or Requests:

Stack/Duct Flow Monitor Required?

Opacity Monitor Required?

Calibration Gas Cylinders Required?

DATA ACQUISITION

Computerized Data Acquisition System Required:

Analyzer Output Types Requested:

Type of EPA Reporting Required:

Distance from System Hardware to Control Room Location:

Ethernet Available at DAS Location?

Integration with Plant DCS Required?

If YES, please specify DCS Type:

Specify any other requirements for a DAS, such as backup storage requirements, printers,

software, networking solutions, etc:

Any other information that you may wish to provide

that you feel will help us to better serve you:

DUST CONTROL DEVICES

(Check all that apply)

EMISSIONS CONTROL DEVICES

(Check all that apply)

Contact Information

Telephone

805-523-8700

FAX

267-295-8536

Postal address

11126 Broadview Drive

Moorpark, CA. 93021

USA