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:

FAX:

E-Mail:

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)

Line Power Available at the System location?

Line Power Available at the Probe location?

Instrument Air Available at the System location?

Instrument Air Available at the Probe location?

Contact Information

Telephone

805-523-8700

Postal address

11126 Broadview Drive

Moorpark, CA. 93021

USA

Email

info@cems-experts.com