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Please make sure to fill out the * part

【Basic information】

Company name *
Division name
Name *
Post code *
Address *
TEL *
FAX *
E-mail address *

【Property of liquid concentrate】

Name of processed material
Previous and post progress
The quantity of sample for the test
Liquid concentrate composition

Boiling point
Volatile
Flammable
Foaming property
Caustisity
PH
Concentration
Specific gravity
Viscosity
Solid True specific gravity
Apparent specific gravity
Particle size
Configuration
Compaction property
Agglomerating property
Sedimentation property
Melting point
Liquid Specific gravity
Viscosity
Aging variation
Safety information Toxicity

Effect to the human body
Precautions for handling
Necessary protective equipment Gloves : Mask : Goggles : Others

【Treatment Condition】

Treatment purpose
Planning machine Separation by filtration
Separation by sedimentation
Quality of material for wetted part

Designation for filter media
Filter media in current use
Through put
Operating hour in a day
Treatment temperature
Estovers
Dehydration temperature
Moisture content rate
Fracture of crystal
Cake Washing
Name of liquid
Wash quantity
Temperature
Purpose
Criterion for determing the effect
Flocculant use
Test place

【Others】

Current treatment
Current problem
Post record for test in other model machine/company  

Cleaning procedure for the used machine in the test
Special note