Plant Name:______________________________________

Application Data Form Address: ________________________________________

MARTIN Silo Solutions®
City:____________________________________________
Telephone:_________________ FAX:__________________ 
Contact Person:____________________________________ State:__________ Zip Code:__________ Date:__________ 

Silo/Bunker name: ������������������������������������� Is there an elevator to the top of container? Yes r No r

(If prints are available, disregard) Air Slides or other fluidizing equipment? Yes r No r
Roof Openings Are there inverted cones or baffles? Yes r No r
D ft/m
Describe _________________________________________________
C ft/m
Is there a working dust collecting system? Yes r No r
A ft/m
Confined space? Yes r No r
B ft/m
Are there instruments or structural
ft/m supports inside of container? Yes r No r
ft/m Any liner or coatings inside container? Yes r No r
Obstructions? Vertical____ Horizontal____ Yes r No r
ft/m
(within 5’ any direction inside or outside of roof opening)?
G F ft/m
Type of Outlet: 110V r 220V r 440V r
ft/m
E
Type of Bottom: Flat r Cone r Sloped r Other r
ft/m
Air supply available: P.S.I.___________________C.F.M._________________
Number of discharge feeders:���������������������������
Number of clogged feeders:���������������������������� Type of Vessel: Silo r Bin r Bunker r Rail Car r
Discharge type: Slide Gate r Rotary Valve r Interstice r Tank r
Vibratory r Other r
How long can container be available for cleaning?______________________
Feed rate:___________________ TONS PER HOUR
Top of Silo: Indoors r Outdoors r
Roof Opening(s):
Is roof sloped? Yes r No r
Square r Round r Rectangle r
Height of lip on manhole: Thickness of roof: If so, what is the pitch/angle?­­_______________________________
_____ft._____in. _____ft. _____in. What is the load rating of the roof? __________________________

(PLEASE CIRCLE OR CLICK ON TYPE OF PROBLEM) Condition of non-flowing material: Wet r Dry r
Temperature of Material (Degrees):�������������������������

Compaction level: Hard r Soft r

% Moisture:��������������������������������������������

Last time cleaned:���������������������������������������

PLUGGED BRIDGED RATHOLE OTHER Method used:�������������������������������������������

(PLEASE SKETCH)
Name of material:�������������������������������������������� _____________________________________________
Estimate amount of non-flowing material:_____________________ TONS Any plant specific safety requirements? Yes r No r
Planned Storage Capacity:________________________________ TONS If so, what? ____________________________________

METHOD FOR REMOVAL OF DISLODGED MATERIAL (explain):

Form No. L3639-10/13

MARTIN ENGINEERING USA

One Martin Place
Neponset, IL 61345-9766
www.martin-eng.com
To submit completed form FAX to 800-814-1553 or E-Mail : silocleaning@martin-eng.com