Engineering Action Request Form — equipment dimensions Engineered Polymer Solutions

Engineering Action Request Form

CONTACT INFORMATION

Name ___________________________________________ Date _____________________________________________

Company ________________________________________ Address __________________________________________
Telephone _______________________________________ e-mail ___________________________________________
Customer ________________________________________

New Tooling Only (Fill out profile and material below)

Seal Profile or Description __________________________ Material __________________________________________

OPERATING CONDITIONS

■ static ■ reciprocating ■ rotary ■ oscillating

Pressure: psi ■ bar ■ Speed: ft/min ■ m/s ■ Temperature: C ■ F■ Media _________________

Operating _____________ Stroke length ___________ Continuous _____________ Gas ■ Liquid ■
Min ___________________ Cycles/min _____________ Min ___________________
Max ___________________ Max ___________________ Name _________________
Direction:
■ Unidirectional pressure RPM __________________
■ Bidirectional pressure
Vacuum: Yes ■ No ■

Describe existing seal problem or expectation:

Describe existing seal design and material:

EQUIPMENT

Application ______________________________________ Surface finish ______________________ Ra ■ RMS ■

Manufacturer ____________________________________ Hardness ________________________________ Rc ■
Model __________________________________________ Plating/Coating ____________________________________
Misalignment _______________ in ______________ mm Eccentricity (T.I.R.) ____________ in ______________ mm
(shaft to bore) or Run-out
See reverse side for equipment dimensioning.

Describe application and/or operating conditions:

89
Engineering Action Request Form — equipment dimensions Engineered Polymer Solutions

Rod Wiper Canned Rod Wiper Rod Seal Rod Packing

L1 L L3
L1

ØC ØD4 ØC ØC
Ød ØD 2 Ød ØD4 Ød ØD 1 Ød ØD 1

Ød: __________ ØD4: _________ Ød: __________ ØD4: _________ Ød: __________ ØD1: _________ Ød: __________ L3: __________
ØC: __________ L1: __________ ØC: __________ L1: __________ ØC: __________ L: ___________ ØD1: _________
ØD2: _________

Rod Wear Ring Piston Seal U-Cup Piston Bidirectional Seal Piston Wear Ring
L2
L
L L2

ØC ØP ØP
ØP
ØD3 Ød ØD Ød5 Ød1 ØD Ød2
ØD Ød1

Ød: __________ ØD3: _________ Ød1: _________ ØP __________ Ød1: _________ ØP: __________ ØD:__________ ØP: __________
ØC: __________ L2: __________ Ød5: _________ L: ___________ ØD:__________ L: ___________ Ød2: _________ L2:___________
ØD:__________

Bidirectional Piston Seal Piston Cup Seal Face Seal O-Ring Gland

L4 L L4 L
L

L ØD1
ØD Ød6 Ød4 L Ød1 ØD Ød
ØP Ød 1
ØD ØCH
Piston Mount Rod Mount
Ød1: _________ ØP: __________ ØD:__________ ØCH:_________ O.D. I.D.
ØD:__________ ØD1: _________
ØD:__________ L: ___________ Ød4: _________ L: ___________
I.D.: __________ L: ___________ Ød1: _________ Ød: __________
Ød6: _________ L4: __________
O.D.: _________ L: ___________ L: ___________

Flanged Shaft Seal Gland Rod Seal Rotary Piston Seal Rotary Rotary Shaft Seal
L L
L
G

ØD 1 ØP
ØC
ØD 5 Ød ØD Ød 1 L
Ød ØD1 Ød ØD

ØD1: _________ G:___________ ØD1: _________ L: ___________ ØD:__________ ØP: __________ ØD:__________ L: ___________
Ød: __________ L: ___________ Ød: __________ Ød1: _________ L: ___________ Ød: __________
ØD5: _________ ØC: __________

90 FORM NO. 071720

Notes Engineered Polymer Solutions
Notes Engineered Polymer Solutions
Notes Engineered Polymer Solutions