Equipment Data Sheet Form Has the chiller been tested by Hudson?*Please SelectYesNoAnalysis Part of Chiller Chemistry?*Please SelectYesNoAnalysis Part of Fluid Chemistry?*Please SelectYesNo Customer Information Customer Name*Contact Name*Address:*City:*State:*Zip Code:*Telephone:*Fax:*Email:*Purchase Order #:*Job Reference:* Equipment Information Chiller Manufacturer:*Please SelectTraneYorkCarrierMcQuayOtherModel Number:*Please Provide Other Manufacturer*Serial Number:*Tonnage:*Chiller Name / Location:*Type of Chiller:Please SelectCentrifugalReciprocatingScrewHermeticOpenGear DriveDirect DriveElectric MotorSteam TurbineOtherCriticality of Equipment:*Please SelectLowMediumHighPlease Provide Other Type of ChillerEnvironment:*Please SelectDustyWetHumidOutsideHeated Sample Point InformationSample Taken By:Sampling Location:Please SelectReturn LineCrankcaseSumpReservoirOtherPlease Provide Other Sampling LocationSampling Method:*Please SelectDrainDrop TubeDipPilot TubeOtherRefrigerant Type:Please SelectR11R12R13R13B1R14R22R23R113R114R116R123R124R125R134aR236faR245faR401AR401BR402AR402BR404AR407AR407BR407CR407FR408AR409AR410AR416AR417AR417CR421AR422AR422BR422DR427AR438AR448AR449AR450AR452AR500R502R503R507R508AR508BR513AR514AR1233zdR1234yfR1234zeSF6OtherPlease Provide Other Sampling Method*Condenser:Please SelectAir CooledWater CooledOtherEvaporator:Please SelectAir CooledWater CooledOtherPlease Provide Other Condenser TypePlease Provide Other Evaporator TypeDate of Last Oil Change: Sample Frequency:*Please SelectMonthlyQuarterlyAnnuallyOtherPlease Provide Other Sample Frequency Lubricant InformationLube Manufacturer:Lube Name:Lube Reservoir (US Gallons):ISO/SAE Grade:cSt @40C:cSt @100C: Equipment InformationModel Number:Serial Number:Comments: This iframe contains the logic required to handle Ajax powered Gravity Forms.
