Customer Application Information

This information is required to properly configure a sensor system to meet your hydrogen detection and/or measurement needs.

Customer Information

Contact Name: / Title: / Date:
Company Name: / End Application:
Street:
City: / State: / Zip:
Country: / Email:
Phone: / Fax:
Purchase Order No.: / Date Needed: / H2scan Quote#:

Basic Information - Items in Blue are required

HY-ALERTA™ 2600 Explosion Proof Area Hydrogen Monitor Configuration
Monitor Configuration / Optional
Equipment
Analog Output
4-20mA
Analog Scale
0-4% Default
Low %H2
High %H2
Set Points, %H2
Alert Relay
Default: 1%
Alarm Relay
Default: 2% / Serial Interface
RS-232
RS-422 / USB Adapter
Yes No
Interconnect Communication Cable
Length
(max 150’)
Gas Composition: It is critical that ALL elements present in the gas mixture be listed. All non-listed gases may affect the warranty of the analyzer. If any gas composition changes beyond the specified range, analyzer performance may be impacted. Contact H2scan with an updated CAI..
Background Gas: / Air / Other (If background gas isNOT Air, then Oxygen and Nitrogen concentrations MUST BE specified below.)
Gas Components / Concentrations / Comments
Ranges at 1 ATM or Other / Min / Max / Nominal / Units
Hydrogen, H2 / % ppm
Is Hydrogen Always Present? Yes No
Nitrogen, N2 / % ppm
Oxygen, O2 / % ppm
Water Vapor, H2O / % ppm %RH
Inert Gases (He, Ar, etc.) / % ppm
Carbon Dioxide, CO2 / % ppm
Alkanes (Propane, Methane, etc.) / % ppm
Alkenes (Acetelyne, Ethene, etc.) / % ppm
Carbon Monoxide, CO / % ppm
Hydrogen Sulfide, H2S / % ppm
Other: / % ppm

Return completed form to: Fax: (661) 775-9515 or Email:

73000006 R2, Customer Application Information, Model 2600 Page 1 of 2

This H2scan Corporation disclaimer covers the validity of quotes based on information provided by the customer on the Customer Application Information form. This customer provided information is used by H2scan to properly configure products that we warrant for the customer application. H2scan disclaims responsibility for any action taken in reliance upon customer provided information. All quotes from H2scan are valid for 60 days following the date of email transmission. Our company accepts no liability for the content of this email, or for the consequences of any actions taken on the basis of the information provided, unless that information is subsequently confirmed in writing. Any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the company. Finally, the recipient should check this email and any attachments for the presence of viruses. The company accepts no liability for any damage caused by any virus transmitted by this email.
H2scan Corporation, 27215 Turnberry Lane, Unit# A, Valencia, CA, 91355 USA,

73000006 R2, Customer Application Information, Model 2600 Page 1 of 2