Customer Survey (TEST) - Benchmark Measurement Solutions

Customer Survey

Project Name *Project Name

Date *

Quote Number *

Customer Name *

Company Name

Street Address

City

State/Province

ZIP / Postal Code

Country

Email Address *

End-User Contact Information

(if different than customer contact information)

End-User Name

Title

End-User Company

Department

Street Address

City

State/Province

ZIP / Postal Code

Country

Phone

Email Address

Site Information (Required)

(where instrument is to be physically installed)

Plant Name *

Street Address *

City *

State/Province *

Country *

Contact Name

Phone

Email Address

Instrument Requested

Quantity

Tag Number(s)

1. Instrument RequestedNote: If handheld or bench top analyzer is selected, please complete questions 2-12 and 28-33 only.

2. Business or Industry of End User

3. Specify the site details for monitoring (select all that apply)

4. Monitoring purpose (select all that apply)

5. Specify the primary source of water to be monitored

6. Specify the target oil, compound or compound type(s)

7. For crude oil or gas condensate

8. Physical state of hydrocarbons in the water

9. Expected concentration range

10. Clarity of water to be measured

Suspended solids

Turbidity measurement

Dissolved gas concentration

11. Other water quality parameters

Typical pH

Typical pH range

12. Sample temperature

Temperature range

Can sample be cooled if >140 F (60 C)?

13. Specify other water treatment chemicals present in water

14. Acceptable metallic wetted parts

15. Process pressure at sample point

16. Do you need a sample probe?yesno

17. Process flow rate

18. Drain conditions

19. Control requirements

20. Alarm relay system requirements

21. High alarm set point

23. Output signal communication protocolNote: HART and ModBus communication is unidirectional and can be used only for identification and monitoring.

24. Specify installation location

25. Ambient conditions

26. Hazardous area requirements

Eex d or Eex p

Class (I, II or III)

Division (1 or 2)

Groups (A, B, C, D or E, F, G)

Temperature code

Eex d or Eex p

Group (I or II)

Category (M1, M2 or 1, 2, 3)

Zone (0, 1 or 2)

Temperature code

27. Hazardous area protection type

28. Regulatory approvalsSelect all that apply

29. Air supply

30. Power available at site

31. Instrument reporting requirement

32. Lab equipment for preparing standards

33. Water monitoring method

34. Replacement instrumentIs this instrument replacing another? Please enter details, including part number

35. Documentation and special testing requirements

36. Analytical equipment and methods at site

37. Critical performance requirements