Pre-Proposal Questionnaire – Sludge Profiler
QMS Management System Issued by: G. Bontekoe – Product Development Manager Date: 10/12/2009 PPQ-SP-001 Rev A

Tank Owner Information and Contacts Section

TANK OWNER INFORMATION:

Company Name:
Plant/Facility name:
Street address:
City: State/Province: Zip code:
  Country:

CONTACT INFORMATION:

Main contact: Office phone: Cell phone:
Receives copy of Report? Yes No E-mail: Fax:
     
Inspection Department contact: Office phone: Cell phone:
Receives copy of Report? Yes No E-mail: Fax:
     
Safety Department contact: Office phone: Cell phone:
  E-mail: Fax:

INVOICE INFORMATION:

Company Name:
Plant/Facility name:
Contact Name:
Street address:
City: State/Province: Zip code:
  Country:

Tank Information Section

General Tank Description
Tank ID/Name: Tank Age: Tank Construction Material:
Tank Diameter: Feet Meters Tank Height: Feet Meters
Roof Condition: Nitrogen Blanket required: Yes No
Roof Type: Fixed EFR IFR
 
  If Fixed, type? Cone Dome Umbrella Other
If IFR, type? Pontoon Steel Pan    
If EFR, ladder present? Yes No    
Tank Ladder: Vertical Circular None
  Railing? Yes No
  Platform? Yes No
Tank Shell/Bottom: Vertical Circular None
  Double Shell? Yes No
  Double Bottom? Yes No   If Yes, Specify:
Year installed:
  Tank Lining? Yes No   If Yes, Specify:
Year installed:
  Bottom? Flat Cone Up Cone Down Gradient:
Product Information: 
 Product Name?
 API Gravity?
 Viscosity?
 Temperature?
 Flash Point?
Sludge Information: 
 Year last cleaned?
 Type of Sludge?
Estimated Sludge Height?

Tool entry information:
Number of possible 4” (or larger) entry points: Specify size and arrangement
Drawings of the roof available? Yes No If yes, please attach/Insert
Pictures of the roof/tank available? Yes No If yes, please attach/Insert
Product Height at time of inspection? For fixed roof the product level needs to be less then 5 feet from the entry point.

Safety Information:
Site Specific Training Required? Yes No  
Can training be performed on site? Yes No If no where would it take place?
Is Breathing Air required? Yes No  
Will Client Provide: Breathing Air? Yes No  
  Fire Extinguishers? Yes No  
  Gas Monitors? Yes No  
  Escape Packs? Yes No  
Site Information:
Permits:
  Work Permit Required? Yes No  
  Hot Work Permit? Yes No Other:
  Lock Out/Tag Out? Yes No  
Operational Constraints:
  Work Hours? Yes No Explain:
  Weather? Yes No Explain:
  Union? Yes No Explain:
  Other? Yes No Explain:

Scheduling and Reporting Information
Desired Inspection dates: Between and

One written report is standard. Are more reports required?

Yes No How many?

*Additional charges may apply based on contract.

NOTE : WITHOUT THE INFORMATION REQUESTED IN THIS FORM, TECHCORR USA, LLC WILL NOT BE ABLE TO PROVIDE AN ACCURATE QUOTATION.

This contains the minimum information in order to provide a proposal.

1485 East Sam Houston Parkway South, Suite 160
Pasadena, Texas 77503, USA

Telephone: + (1) 713-524-2768
Fax: + (1) 713-524-3461

TechCorr Pre-Proposal Questionnaire Sludge Profiler