| Protherm Chart Recorder Data Sheet | Item No. |
| New or Replacement Chart Recorder Application? | _____________________ |
| If Existing Chart Recorder Replacement Provide Model No. | _____________________ |
| Chart Diameter or Size | _____________________ |
| Chart Speed (hours per revolution if round) | _____________________ |
| Power Supply to Recorder (120 vac or other) | _____________________ |
| Are Loop Power Supplies Required?(if yes specify) | _____________________ |
| PEN INPUTS AND DISPLAY OUTPUTS | |
| Pen 1, Color of Pen, Name of Reading | |
| Specify (4-20 ma), (0-5 vdc) or other | _____________________ |
| Max Reading, and units | _____________________ |
| Min Reading, and units | _____________________ |
| Linear or Square Root Profile | _____________________ |
| Totalizer Required (Yes or No) | _____________________ |
| Pen 2, Color of Pen, Name of Reading | |
| Specify (4-20 ma), (0-5 vdc or other | _____________________ |
| Max Reading, and units | _____________________ |
| Min Reading, and units | _____________________ |
| Linear or Square Root Profile | _____________________ |
| Totalizer Required (Yes or No) | _____________________ |
| Pen 3, Color of Pen, Name of Reading | |
| Specify (4-20 ma), (0-5 vdc) or other | _____________________ |
| Max Reading and units | _____________________ |
| Min Reading and units | _____________________ |
| Linear or Square Root Profile | _____________________ |
| Totalizer Required (Yes or No) | _____________________ |
| Pen 4, Coloro f Pen, Name of Reading | |
| Specify (4-20 ma), (0-5 vdc) or other | _____________________ |
| Max Reading and units | _____________________ |
| Min Reading and units | _____________________ |
| Linear or Square Root Profile | _____________________ |
| Totalizer Required (Yes or No) | _____________________ |
| OTHER SPECIFICATIONS | |
| _________________________________________ | _____________________ |
| _________________________________________ | _____________________ |
| REQUIRED DELIVERY DATE | _____________________ |
