Documentnr.

: PLOG-005-01 Revision: 10 / 04 April 2007

Skalar Application Questionnaire

SKALAR
APPLICATION QUESTIONNAIRE SANplus

Please fill in this form completely and send together with your order.
Incompleteness will lead to wrong processing
Your order no.: ________________________________________________ Date : _______________________

Reference to Skalar quotation number: ___________________________ Date : _______________________

Clause: The specifications in this APPLICATION QUESTIONNAIRE shall prevail over all other specifications
mentioned in other forms, as in your written order!
Authorization:
Company : __________________________________________________

Name : __________________________________________________

Signature : __________________________________________________

This application questionnaire always consists of Sections 1, 2 and 3.

Section 1
GENERAL:

Tick which item applies.

System Voltage: O 110V/60Hz System Plugs: O (USA style plug) O (UK style plug)
O 220-240V/50Hz O (European style plug) O (Danish style plug)

Existing SAN++ user: O yes, please send details (orderno., copy of methods, etc.) of the existing analyzer
_________________________________________________________________
O no
Hardware, supplied by customer / agent: O Computer, name / type: ________________
O Density meter, name / type ________________
O Refracto meter name / type ________________
O Other: ______________________________
Customer s samples, to be sent for testing at ordered system: O yes (if samples are already analyzer
please mention sample ID no_____
O no

The Skalar processing department will send instructions when the samples and/or hardware (including manuals), have to
be at the Skalar test laboratory in Breda. Skalar is not responsible for the transport and malfunctioning of the hardware.

Skalar reserves the right to consolidate shipment

Otherwise specify shipping instructions: __________________________________

Installation required: O no O yes, by Skalar, The Netherlands

Training required: O no O yes, at Skalar laboratory in Breda, The Netherlands

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Documentnr.: PLOG-005-01 Revision: 10 / 04 April 2007
Skalar Application Questionnaire
Section 2
Chemistry Applications:
Component to analyze ___________________________ Following number: ______
(Full name) (maximum ranging from 1 to 16)
Range: (I) _____________________________
(ranges = concentrations in solution which is finally offered (II) _____________________________
to the system with addition of the Dimension and Chemical (III)_____________________________
Symbol, (e.g. 0.2 1.0 mg P/liter or 10 500 g PO4/liter ;
2 100 mg N or NO3/liter)
Catalogue number Chemistry Module: ___________________
Additional remarks: ___________________________________
(E.g. switching valve, predilution, dialyzer, reactor, etc.) ___________________________________

Component to analyse ___________________________ Following number: ______

(Full name) (maximum ranging from 1 to 16)
Range: (I) _____________________________
(ranges = concentrations in solution which is finally offered (II) _____________________________
to the system with addition of the Dimension and Chemical (III)_____________________________
Symbol, (e.g. 0.2 1.0 mg P/liter or 10 500 g PO4/liter ;
2 100 mg N or NO3/liter)
Catalogue number Chemistry Module: ___________________
Additional remarks: ___________________________________
(E.g. switching valve, predilution, dialyzer, reactor, etc.) ___________________________________

Component to analyze ____________________________ Following number: _____

(Full name) (maximum ranging from 1 to 16)
Range: (I) _____________________________
(ranges = concentrations in solution which is finally offered (II) _____________________________
to the system with addition of the Dimension and Chemical (III)_____________________________
Symbol, (e.g. 0.2 1.0 mg P/liter or 10 500 g PO4/liter ;
2 100 mg N or NO3/liter)
Catalogue number Chemistry Module: ___________________
Additional remarks: ___________________________________
(E.g. switching valve, predilution, dialyzer, reactor, etc.) ___________________________________

Component to analyze ____________________________ Following number: ______

(Full name) (maximum ranging from 1 to 16)
Range: (I) _____________________________
(ranges = concentrations in solution which is finally offered (II) _____________________________
to the system with addition of the Dimension and Chemical (III)_____________________________
Symbol, (e.g. 0.2 1.0 mg P/liter or 10 500 g PO4/liter ;
2 100 mg N or NO3/liter)
Catalogue number Chemistry Module: ___________________
Additional remarks: ___________________________________
(E.g. switching valve, predilution, dialyzer, reactor, etc.) ___________________________________
COPY PAGE TO ADD MORE MODULES TO THIS SECTION.
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Documentnr.: PLOG-005-01 Revision: 10 / 04 April 2007
Skalar Application Questionnaire
more applications on a second form Section 2.

Section 3
Sample Matrix.
Sample pretreatment procedures are available at the Skalar Information CD-ROM for Continuous
Flow Analyzer, version 1 and up. This CD-ROM is available on request.
At "*Pretreatment no." column fill in the corresponding appendix number.

If you dont use this Skalar pretreatment, supply to Skalar your sample pretreatment procedure in
detail in a separate appendix!

Tick all matrices which apply. *Pretreatment no. Applies to applications

number:
A. Water O Drinking Water ______________________________ _____________________
O Sea Water ______________________________ _____________________
O Surface water ______________________________ _____________________
O Waste Water ______________________________ _____________________
O Other Water ______________________________ _____________________
B. Extract O Food ______________________________ _____________________
O Plant ______________________________ _____________________
O Soil ______________________________ _____________________
O Other ______________________________ _____________________
C. Digest O Food ______________________________ _____________________
O Plant ______________________________ _____________________
O Soil ______________________________ _____________________
O Water ______________________________ _____________________
O Other ______________________________ _____________________
D. Liquors O Beer ______________________________ _____________________
O Malt ______________________________ _____________________
O Beverage ______________________________ _____________________
O Wine ______________________________ _____________________
E. Detergent O Dust ______________________________ _____________________
O Powder ______________________________ _____________________
F. Fertilizer O Liquid ______________________________ _____________________
O Powder ______________________________ _____________________
G. Tobacco O Tobacco ______________________________ _____________________
H. Pharmaceutical O Pharmaceutical ______________________________ _____________________
I. Milk O Pasteurized Milk ______________________________ _____________________
O Raw Milk ______________________________ _____________________
J. Other O ___________ ______________________________ _____________________
O ___________ ______________________________ _____________________

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