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Our objective is to quickly get you the information you need to solve your silo cleaning problem. We have created the following detailed questionnaire designed to help us understand your specific situation and then develop an action plan and estimate for involved services.

11. CONTACT INFORMATION

22. PROBLEM DESCRIPTION

33. MATERIAL DETAILS

44. VESSEL DETAILS

55. PROJECT SCHEDULE

1. CONTACT INFORMATION

Company Name *

Date *

Job Title

Facility Name

Contact Name *

First

Last

Layout

Mailing Address *

Address Line 1

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Shipping Address *

Address Line 1

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone Main *

Mobile / Cell

Fax

Email *

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2. PROBLEM DESCRIPTION

Typical Vessel Problems

• FUNNELING
• RATHOLING
• PLUGGING
• DOMING
• BRIDGING
• CAKING
• WALL BUILD-UP / SCALE
• UNKOWN

Duration Of Build-Up

Weeks

Months

Years

Date of Last Cleaning

Cleaning Method Used

Describe the Problem

Type of Inspection

• 100% Coverage
• Spot Specific

Recorded Date Set Expected?

• Pictures
• Videos

Are asset drawings available? (If yes, please upload here)

Click or drag files to this area to upload. You can upload up to 10 files.

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3. MATERIAL DETAILS

Name and Description

Description of the Material (Check all that apply)

• Wet
• Dry
• Burnt
• Hot
• Jackhammer Hard
• Contaminated
• Pick Hard
• Frozen
• Compacted
• Explosive
• Toxic
• Food Grade
• Shovel Hard

Other (please describe)

Will water, or other liquid material be present in the asset at the time of the inspection?

• Yes
• No

Are there other workers inside of the asset during proposed inspection date?

• Yes
• No

How High Does Non-Flowing Material Extend Up the Walls?

in.

ft.

cm.

m.

Checkboxes

• Don't Know

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4. VESSEL DETAILS

A. Vessel Information

Vessel Name

Vessel Number

Date of Construction (year)

B. Vessel Construction

Concrete

• Slip Form
• Jump
• Stave

Steel (check all that apply)

• Welded
• Bolted
• Corrugated

Other (please describe)

C. Cone Construction

Cone Construction

• Concrete
• Steel

Other (please describe)

D. Vessel Type

Type of Vessel - Please Select From Images as Shown Below

• Round
• Square
• Rectangle
• Divided / Segmented
• Divided / Silo Within Silo

Other (please describe)

E. Roof Openings

Number of Openings (How Many Openings):

Measurements Using:

• Inches
• Feet
• Meters

Opening #1

Shape #1

• Round
• Square
• Rectangle

Measurement #1

Opening #2

Shape #2

• Round
• Square
• Rectangle

Measurement #2

Opening #3

Shape #3

• Round
• Square
• Rectangle

Measurement #3

Opening #4

Shape #4

• Round
• Square
• Rectangle

Measurement #4

Opening #5

Shape #5

• Round
• Square
• Rectangle

Measurement #5

Air Slides or Other Fluidizing Equipment?

• Yes
• No

If Slides or Other Fluidizing Equipment Exists, Please Describe

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5. PROJECT SCHEDULE

How long will the vessel be available for service?

Shift Preference

• Single Shift
• Around-the-Clock

Is Vessel Available to Work Weekends?

• Yes
• No

Start Date

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