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Contact Info
Dealers & Partners
Plant Survey Form
On-Line
Company Name:
*required field
Plant Number / Name:
Plant Address:
City, State, Zip:
Contact:
*required field
Phone / Cell Number:
*required field
E-mail Address:
*required field
Submitted By:
*dealers only
Additional Contact Info:
Plant Section
Plant Manufacturer:
Plant Model:
Direct Wired or Amphenol Quick Connect:
Wired to J-Box
Amphenol Quick Connects
Hood Control:
None
Fixed
Manual Up/Down
Boot Control:
Fixed
Manual Up/Down
Do You Need to Order a Printer:
Yes
No
Would You Like Remote Batch on This Plant:
Yes
No
Current Batch Control System:
Notes:
Aggregate Section
Number of Aggregate Bins:
1
2
3
4
5
6
7
8
Number of Aggregate Materials:
1
2
3
4
5
6
7
8
Aggregate Scale Capacity (lbs.):
Load Cells Installed:
Yes
No
Scale Indicators:
Yes
No
If "Yes" Make & Model of Indicator:
Aggregate Discharge Type:
Gravity
Live Bottom
Special
If "Special" Please Describe:
Do you have a Moisture Probe:
Yes
No
If "Yes" Make & Model of Probe:
Do You Need to Order a Moisture Probe:
Yes
No
If "Yes" How Many:
0
1
2
3
4
Notes:
Cement Section
Number of Silos:
1
2
3
4
5
6
Number of Cement Materials:
1
2
3
4
5
6
Cement Scale Capacity (lbs.):
Load Cells Installed:
Yes
No
Scale Indicators:
Yes
No
If "Yes" Make & Model of Indicator:
Cement Discharge Type:
Gravity
Auger
Special
If "Special" Please Describe:
Is There a Recirculating Scale Screw:
Yes
No
Cement Scale Aeration:
Yes
No
Cement Shakers:
Yes
No
If "Yes" How Many:
0
1
2
3
4
5
6
Shaker Type:
Manual
Automatic / Timed
Cement High Indicators:
0
1
2
3
4
5
6
Cement Low Indicators:
0
1
2
3
4
5
6
Dust Collector:
Yes
No
Notes:
Water Section
Number of Waters:
1
2
3
4
Water Feed Type:
Metered
Weighed
Holding Tank
If "Metered" Water Meter Type:
Does Meter Supply 110V Output Signal:
Yes
No
Water Pump:
Yes
No
If "Yes" How Many:
0
1
2
3
4
If "Weighed" Water Scale Capacity (lbs.):
Scale Indicators:
Yes
No
If "Yes" Make & Model of Indicator:
Water Valve Type (Solenoid):
Single Action
Dual Action
Water Tank Empty Limit:
Yes
No
Water Scale/Tank Closed Indicator:
Yes
No
Notes:
Admixture Section
Number of Admixtures:
1
2
3
4
5
6
7
8
9
10
11
12
Admix 1 Name and Type:
Bottled
Direct
Admix 2 Name and Type:
Bottled
Direct
Admix 3 Name and Type:
Bottled
Direct
Admix 4 Name and Type:
Bottled
Direct
Admix 5 Name and Type:
Bottled
Direct
Admix 6 Name and Type:
Bottled
Direct
Admix 7 Name and Type:
Bottled
Direct
Admix 8 Name and Type:
Bottled
Direct
Admix 9 Name and Type:
Bottled
Direct
Admix 10 Name and Type:
Bottled
Direct
Admix 11 Name and Type:
Bottled
Direct
Admix 12 Name and Type:
Bottled
Direct
Notes:
Mixer Section
Mixer Type:
None
Tilt Mixer
Pan Mixer
Twin-Shaft
Inventure
Dual Mixer
Mixer Hydraulics:
Yes
No
Mixer Tilt and Right Limits (if tilt mixer):
Yes
No
Slump Meter:
Yes
No
Mixer Closed Limit (if pan mixer):
Yes
No
Temper Feed:
Yes
No
Erie Mixer 10% Limit Controls:
Yes
No
Notes:
Additional Plant Notes, Comments or Recommendations