MANUFACTURING # :

TYPE :

MODEL :

SIZE :

Materials of Construction:

If Yes, how much? :

:

Equipment Design Pressure (MAWP) :

Vacuum conditions : NoYes

Yes No

Yes No Yes No

Yes No

Yes No

Yes No Backpressure:

Burst Pressure :

Is there a safety relief valve above the disc? Is non-fragmenting design required?

If Yes, is FDA / 3A approval required?Sanitary application?

Is vacuum relief required? If Yes, how much? : Unit of Measurement:

Is the application...? If cyclic or pulsating, what is the frequency?

Any code requirements (e.g. ASME)?

Is CE mark required?

Other special conditions?Any required accessories or options?

COMPANY NAME :

CITY

COUNTRY CONTACT

EMAILPHONE #

Temperature :

Temperature :

Size :

Rating Type :

Unit of Measure

:Unit of Measure

Unit of Measure

Unit of Measure

Pressure:

INQUIRY NUMBER

Will gas / vapor or liquid media burst the disc?

Manufacturing Range:

Yes No

Disc Quantity : Holder Quantity :

Piping connections?

POSTAL CODESTATE

END USER / COMPANY NAME :

COUNTRY WHERE PART TO BE USED :

END USE OF PRODUCT?

:

:

REORDER

Rupture Disc

Burst

Operating

Vacuum Burst Rating

of Construction:Holder Materials

Holder Type:

Operating

See Burst Rating Type Datasheet

to