northstarequip
Requesting Company: Date:
Conveyor Identification/Reference: Conveyor Belt Width: (inches)
Conveyor Belt Length: (feet) Design Capacity: (tons/hour)
Design Belt Speed: (feet/min)(tbd) Conveyor Lift or Angle of Operation: (degrees or feet)
Material Conveyed: Material Density: (lbs/ft3)
Material Angle of Repose: (degrees) Special Idler Requirements: (CEMA C, Impacts, Spacing) Describe in Detail Below:
Special Belt Requirements: (2 Ply, 3 Ply, Chevron, Other) Special Head or Tail Requirements: (Herringbone, Ceramic, Spiral, Plain) Special Load Zone Requirements: (If other than Standard 4’-0”)
Conveyor Type: (Stacker,Channel, Truss or Other) Specify Truss Depth: Gravity Take-Up: (Yes or No) YesNoOption 3 Legs or Supports: Describe:
Special Motor Requirements: (if other than 1800 rpm/230/460V/60 Hz/TEFC) (Voltage, Inverter Duty, Explosion Proof) Special Paint Requirements: (if other than Grey Enamel) (Urethane, Epoxy, Different Color)
