SEAL ANALYSIS REQUEST FORM

Name:

Email:

Phone:

Fax:

Company:

Address:

Customer (if form filled out for another party):

Provide as much information as possible.
If possible, provide pictures of seals and conditions of valve prior to and following removal.

Car #(s):

Car Type: (Pressure or GP):

Operating Pressure:

Operating Temperature:

Contents of Car: (Must Provide SDS):

Valve Model(s):

Valve Serial Number:

Seal Part Number(s):

Seal Material:

Date Seals Installed:

Date of Removal/Failure:

Trelleborg Compound: (Y/N)

Yes

If seals not supplied by Trelleborg, please provide supplier/compound info if possible:

Describe Mode of Failure: (e.g., type of leakage, when failure occurred, etc.)

Service Conditions: (i.e., temperature/pressure conditions, heating during loading/unloading/etc.)

Additional Info:

Standard Analysis
Includes: Visual inspection, dimensional checks, durometer check

Elastomer Material Analysis
Includes: FT-IR analysis to verify material compound

Contaminant Analysis
Includes: Material analysis of any lubricants or contaminants found on seal

Advanced Analysis
Includes: Standard Analysis, Elastomer Material Analysis, TGA Analysis

Additional Services Requested:

Return Seals to Sender (Y/N):

Yes

Send Copy of Completed Analysis to:

Name/Company:

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Email:

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Additional Info:

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