Date:    Customer Name

Address    City    State/Prov.

Zip    Contact Name    Phone  

Fax.        Conveyor name or #

REPLACEMENT or NEW

                                                                                                                                vulcanized/mach.
Widthin.    Lengthft.    Belt Speedfpm    Type of Splice  

Splice lengthft/in                    Temp. Range^o F

CONVEYOR SPECS. GENERAL
***INCLUDE SIDE VIEW DRAWING OF CONVEYOR ON A SEPARATE SHEET***

INCLINE                 DECLINE                 HORIZONTAL

Length CCft.         Horizontal Centersft.    Total Rise/Dropft.

Slope (degrees)^O    Type of Take-upmax.    Travelft.

Weight (gravity)lb.    Location of Take-up

Does Conveyor Reverse (yes/no)

Head Transitionft.        Tail Transitionft.

Idler Type    Trough Angle^o    Dia. of Idlersin.

Spacing of Idlersft.    Pulley Diameters    Headin.     Tailin.

Snubin.    Bend^o

Return Idler Type    dia.    Spacing

Drive Location        Drive Type        Lagging/Type

Wrap (Total degrees of wrap of all driving pulleys)^o                 Motor H.P.    

Drive Pulley Sizein.        Start Type (hard/soft)  

Drive Pulley         FLAT        CROWNED         

Max. Deceleration rate (loaded)         Brake/Backstop

                                                                                                                                  Peak
Material. Type        Weight (lb/ft³)        Capacity (TPH)

Lump Size (max.)    WET    DRY    Material Temperature^o F   

Percent of Fines%        Any Oils Present/type

Other Chemicals Present    Number of Load Points

Location of LPs    Drop Distance ft.    Chute Angle^o   Impact Rollers

Load: (top, side, other)

DISCHARGE POINTS

Head Pulley Discharge? (yes/no)     Trippers? (yes/no)     Discharge Plows? (yes/no)

Manufacturer    Years In Service    Cause of Failure

Carcass Fabric    #Plies    A.W.T.     Cover Compound

Tons Conveyed/hr         Oil Degradation (yes or no)

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