Your Data
Company Name				Contact Person
Address				Telephone
City	State	Zip		Fax Number
Bin/Silo Data
Please specify each dimension that applies to your bin/silo and indicate unit of measure for each as: Ft=feet, cm=centimeters In=Inches, m=meters				A
				B
				C
				D
				E
				F
				G
				H
				J
				K
		Yes	No	Bin Top: Indoors Outdoors
Is there an elevator to the top of the silo?
Are there explosion-proof lights available?				Electrical Supply: 220-240V 3Ph Yes No 440-480V 3Ph Yes No
Are there explosion-proof outlets?
Are there instruments in the silo?				Silo/Bin Construction
Is there a dust collection system?					Concrete
Obstructions (above or below)					Steel
Describe (within 2' any direction)					Other
					Silo Indentification #
Manhole Opening: Square Round Rect ft. in. x ft. in. Depth: ft. in.
Bin/Silo Condition
				Other, please specify:
Description of Material:				Quantity (Approximately)
				Duration of clog:
				Poisonous? Yes No
Additional Notes
Please briefly explain your situation, or include any details not covered above:

Should your situation be of a more immediate need, please don't hesitate to call 1-800-458-9446 or 507-345-4553. Fax: 507-345-3639

Or our snail mail address:
(TOP)

Pneumat Systems, Inc.
55051 Gadwall Rd.
Mankato, MN 56001

1-800-458-9446
507-345-4553
FX: 507-345-3639

E-Mail

Pneumat Systems/Europe
Bold Business Center, #22
Bold Lane, Sutton, St. Helens
Merseyside, WA9 4TX
England

44(0)1925-290080
FX: 44(0)1925-290085

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