Company Name

Contact Person

Company Address

City

State

Zip Code

Phone Number

Email Address

Name of process liquid (product) to be measured

CAS-Number of the chemical

List compounds/ingredients of the process liquid

Point-of-use of the instrument Point-of-use of the instrument Control of incoming goods Quality control Process control Process monitoring

Display of IPR Display of IPR Not required Refractive index [RI] Dry substance [Brix] Custom scale (extra costs)

Measuring Range RI Measuring Range RI1.3200 – 1.52001.32000 – 1.52000 nD (Explosion Proof)1.3320 – 1.53001.3320 – 1.37201.3320 – 1.4209

Measuring Range Brix Measuring Range Brix0 – 25 Brix0 – 50 Brix (automatic temperature correction 10°C – 50°C)0 – 85 Brix (automatic temperature correction 10°C – 50°C)0 – 90 Brix (automatic temperature correction 10°C – 50°C)0 – 100 Brix

Resolution Resolution0.0001 RI / 0.05% DS [Brix]0.00001 RI / 0.01% DS [Brix]0.000005 RI / 0.002% DS [Brix]0.000001 RI/0.001% DS [Brix]

Required Accuracy Required Accuracy±0.00014nD±0.00004nD±0.02 Brix (±0.01 – 2% Brix at 20°C)± 0.00007nD±0.02 Brix±0.05 Brix (at 20°C)±0.01 – 2% Brix (at 20°C)

Ambient Temperature Ambient Temperature-10°C to + 45°C0°C to + 45°C-10°C to + 50°C-20°C to +65°C+ 10°C to + 40°C15°C – 40°C

Process Temperature Process Temperature-10°C to 65°C0°C to +90°C-10°C to +90°C-20°C to +120°C (Explosion Proof)-10°C to + 80°C (without water cooling)-10°C to +100°C (with water cooling installed)-10°C to +150°C (with water cooling installed)

Mounting Pipe Diameter

Expected Flow Velocity (m/sec)

Do you currently measure or control your process? Do you currently measure or control your process? Yes No

If yes, how do you measure?

Is Viton an acceptable sealing material? Is Viton an acceptable sealing material? Yes No

Additional application notes you would like to provide: