- To be used for new and replacement Isolation Valves (with or without actuation)

General Information

Date: Click or tap here to enter text.	Company: Click or tap here to enter text.

Contact Name(s): Click or tap here to enter text.

Email: Click or tap here to enter text.	Phone: Click or tap here to enter text.

Requested Delivery Date: Click or tap here to enter text.

Quantity: Click or tap here to enter text.

Tag number(s):	Click or tap here to enter text.

IF Replacing existing OR duplicating existing Isolation valve complete the following section:

Model and Serial Number(s) (From body and actuator): Click or tap here to enter text.

Type/Brand and Size of Actuator: Click or tap here to enter text.

Type/Brand and Size of Valve Body: Click or tap here to enter text.

Valve Name Plate Info ALL: Click or tap here to enter text.

Actuator Name Plate Info ALL: Click or tap here to enter text.

Topworks/Accessories Name Plate Info ALL: Click or tap here to enter text.

Type of Control Signal (4-20mA, 3-15 PSI, 0-10 V Bus, Other?): Click or tap here to enter text.

List of Accessories with model numbers (Handwheel, Boosters, Trip, Solenoid): Click or tap here to enter text.

Normal/Design Air Line Supply Pressure: Click or tap here to enter text.

New Isolation Valve Application complete the following section:

Valve Type (Ball, Plug, Butterfly, other): Click or tap here to enter text.

Fluid/Gas Type: Click or tap here to enter text.

Line Size: Click or tap here to enter text.	Pipe Schedule: Click or tap here to enter text.

ANSI Class (150, 300, 600, 900, 1500, 2500): Click or tap here to enter text.

End Connection Type (NPT, Flat Face, Raised Face, SWE, BWE):	Click or tap here to enter text.

Normal/Design Air Line Supply Pressure: Click or tap here to enter text.

Material of construction if customer specifies: Click or tap here to enter text.

Upstream/Inlet Pressure: Click or tap here to enter text. Units: Click or tap here to enter text.

Downstream/Outlet Pressure: Click or tap here to enter text. Units: Click or tap here to enter text.

Bidirectional Shutoff Requirement: Click or tap here to enter text.

If Control Flow complete the following:

Minimum Flow Rate: Click or tap here to enter text. Units: Click or tap here to enter text.

Normal Flow Rate: Click or tap here to enter text. Units: Click or tap here to enter text.

Maximum Flow Rate: Click or tap here to enter text. Units: Click or tap here to enter text.

Temperature: Click or tap here to enter text. Units: Click or tap here to enter text.

Fail Mode (Open, Closed or Fail Last Position): Click or tap here to enter text.

Type of Control Signal (4-20mA, 3-15 PSI, 0-10 V, Bus, Other?): Click or tap here to enter text.

List of Accessories (Handwheel, Boosters, Trip, Solenoid, Limit Switch(s)): Click or tap here to enter text.