Company Name*:

Address*:

Address 2:

City*:

State/Province*:

Zip/Postal Code*:

Country*:

Phone Number*:

Fax Number:

E-mail Address:

Exhaust to incinerator (ACFM):

Type of solvent emitted:

Rate of solvent emitted:

Source of Effluent:

Temperature of exhaust:

Mounting location:

Gas:

Gas Pressure Available:

Heat recovery desired?