Product Check List This is a Request for a Quote Order P.O.#_______ Quantity Needed _____________ Photocopy This Form Use one form for each product type you are selecting. This form may also be completed online at gemssensors.com for RFQ. Date Required ____/____/_____ Shipping Method:_____________ Partials Accepted: Yes No Name ___________________________________________ Company _________________________________________ Street ___________________________________________ City________________________ State_____ Zip__________ Phone ( _____ ) ___________________________________ Fax ( _____ ) ______________________________________ LS-350 Engineered Plastics Custom Length with Siphon Tube Float Type Level Switch Check List Application Environmental Conditions This information is essential to the accurate and proper operation of your GEMS configurable sensor. Please complete fully and accurately before ordering. 1. Liquid Media: _________________________________________ 5. Viscosity: _________________ SSU psig 2. Pressure: Minimum __________ bar °F 3. Temperature: Minimum _______ °C 6. Tank Material: ________________________________________ 4. Specific Gravity: Minimum _____ Maximum _________ Maximum °F _________ °C Maximum _________ Tank Depth: __________________________________________ 7. Unit is Mounted In: T - Top Mounted B - Bottom Mounted 6. Switch Actuation Level: 1. Mounting Type: Type 1 (Standard) Type 2 Actuation Level 2. Float Type: Distance to Actuation Level* Inches Millimeters SPST Switch Operation** (Check Type) N.O. Buna-N - P/N 128462 Solid Foamed Polypropylene - P/N 130893 (Standard) N.C. L4 L3 3. Electrical Rating: 010 - SPST, 10VA 020 - SPST, 20VA 050 - SPST, 50VA 100 - SPST, 100VA 4. Wiring Group: Group 1 - Common Return Group 2 - Independent Return L1*** * Measured from inner surface of mounting plug or flange. See mounting types on page B-11. ** Switch position is " normal " with unit dry (tank empty). *** L1 is the distance to the lowest actuation level with mounting " up, " and is the distance to the highest actuation level with mounting " down. " B. Length Overall _________________ Inches Millimeters 5. Electrical Connections: L2 7. Barb Fitting: Type Description 3/16 " (Standard) 1 Lead Wires, 24 " to 26 " (610mm, Min.) 2 Cable, 24 " to 26 " (610mm, Min) Other_____________________________________________ Please contact GEMS Sensors Inc. for any configuration or special requirements not covered on this form. 800-378-1600 Quote $ _________________ B-13 Date Quoted ____/____/____ Visit www.GemsSensors.com for most current information. LS-350 Series / p4of4 / 3-APR-14http://ecatalog.gemssensors.com/ecatalog/configurators/LS350 http://www.GemsSensors.com