Installation, Controls and Protective Devices

Date ______ /______/_______ Filled In By _______________________________ RMA No. _______________

Installation:

Owner/User ________________________________________________ Telephone (______) ____________________

Address ____________________________________________City _______________ State ______ Zip __________

Installation Site, If Different _________________________________________________________________________

Contact ___________________________________________________ Telephone (______) ____________________

System Application________________________________________________________________________________

_______________________________________________________________________________________________

System Manufactured By_____________________________Model ________________ Serial No. _______________

System Supplied By_________________________________ City _________________ State ______ Zip _________

Is this a “HERO” system (10.0 - 10.5 PH)? ❑ Yes ❑ No

Model No. _______________ Serial No. _______________ Date Code ______

Horsepower ______ Voltage ______ ❑ Single-Phase ❑ Three-Phase Diameter ______ in

Slinger Removed? ❑ Yes ❑ No Check Valve Plug Removed? ❑ Yes ❑ No Motor Fill Solution ❑ Standard ❑ DI Water

Manufacturer _______________ Model _______________ Serial No. _______________

Stages ______ Diameter ________ Flow Rate Of ________ gpm At ______TDH

Booster Case Internal Diameter ________ Material _______________

SubMonitor? ❑ Yes ❑ No If Yes, Warranty Registration No._______________________________________

If Yes, Overload Set? ❑ Yes ❑ No ______ Set At _________________________

Underload Sets? ❑ Yes ❑ No ______ Set At _________________________

VFD or Reduced Voltage Starter? ❑ Yes ❑ No If Yes, Type __________________________________________

Mfr. ______________Setting ________% Full Voltage In ________sec

Pump Panel? ❑ Yes ❑ No If Yes, Mfr. ______________________________Size _______________________

Magnetic Starter/Contactor Mfr. ___________________________ Model __________________Size_______________

Heaters Mfr. _____________________ No. ____________ If Adjustable Set At _______________________________

Fuses Mfr. ____________________ Size ___________ Type _____________________________________________

Lightning/Surge Arrestor Mfr. ________________________ Model __________________________________________

Controls Are Grounded to __________________ with No. ________Wire

Inlet Pressure Control	❑ Yes	❑ No If Yes, Mfr.________ Model _______ Setting _____ psi	Delay ____ sec
Inlet Flow Control	❑ Yes	❑ No If Yes, Mfr.________ Model _______ Setting _____ gpm	Delay ____ sec
Outlet Pressure Control	❑ Yes	❑ No If Yes, Mfr.________ Model _______ Setting _____ psi	Delay ____ sec
Outlet Flow Control	❑ Yes	❑ No If Yes, Mfr.________ Model _______ Setting _____ gpm	Delay ____ sec
Water Temperature Control ❑ Yes		❑ No If Yes, Mfr.________ Model _________________________ Delay ____ sec
	Set At ________ °F Or ______ °C Located _____________________________________

Form No. 3655 8/00