Disogrin® LSU Seals - Simrit
Disogrin® LSU Seals - Simrit
Disogrin® LSU Seals - Simrit
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Seal Application Request<br />
DISOGRIN Seal Application Request will<br />
enable us to assist you in your sealing needs.<br />
❐ ROD APPLICATION<br />
Fill in dimensions, tolerances:<br />
(Circle one: Inches or Millimeters)<br />
❐ PISTON APPLICATION<br />
Fill in dimensions, tolerances:<br />
(Circle one: Inches or Millimeters)<br />
µ inches<br />
µ meters<br />
µ inches<br />
µ meters<br />
µ inches<br />
µ meters<br />
µ inches<br />
µ meters<br />
Dia.<br />
when new:<br />
Dia.<br />
Dia.<br />
when new:<br />
Dia.<br />
Speed: cycles/minute: ____________; Length of stroke: ____________in. or mm.; Average speed: ____________ft./sec. or m./sec.<br />
Temperature: normal: ____________ o F or o C min: ____________ o F or o C max: ____________ o F or o C.<br />
Application: ___________________________________________________________________________________________<br />
Media to be sealed: ______________________________________________________ Viscosity: ______________________.<br />
Pressure: normal: _______________ psi or BAR; min: ____________ psi or BAR;<br />
max: ____________ psi or BAR.<br />
Size: (see above).<br />
Project name or # _______________________________________________________ ❐ New Design ❐ Replacement<br />
Estimated usage: monthly ________________; total ________<br />
Application Assembly Prints with all<br />
necessary dimensions and tolerances<br />
should be supplied if possible.<br />
Special Requirements for seal and specific<br />
environmental or operating conditions should be<br />
described more completely:<br />
__________________________________________<br />
__________________________________________<br />
__________________________________________<br />
__________________________________________<br />
__________________________________________<br />
__________________________________________<br />
__________________________________________<br />
* Reference page 6 for Part Numbering Nomenclature<br />
Name: _________________________________________________<br />
Title: ___________________________________________________<br />
Company: ______________________________________________<br />
Address: _________________________________________________<br />
City: ___________________________________________________<br />
State: __________________________ Zip: ___________________<br />
Telephone: (<br />
FAX: (<br />
) _________________________________________<br />
) ______________________________________________<br />
Send Application Request To:<br />
SIMRIT<br />
3600 West Milwaukee<br />
Spencer, IA 51301<br />
Phone: 712.262.4867<br />
Fax: 800.343.4145<br />
-<strong>LSU</strong> <strong>Seals</strong><br />
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