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150 EHLT / EHLTX / PST                     CUSTOMER INFORMATION
       ERGONOMIC SOLUTIONS  SCISSOR LIFT TABLES        TABLE SPECIFICATIONS



                   EHLTD / EHLTS
                                                         CONTACT:

                                                         COMPANY:
                   EHLTSD / AHLT

                                                           PHONE:

                                                            EMAIL:
                        SURVEY SHEET
                                                       MODEL NUMBER:
                                                       DECK SIZE (W x L):
                   DECK
                                          DECK
                                                       RAISED HEIGHT:
                   WIDTH
                                         LENGTH
                                                       LOWERED HEIGHT:
                                                       TRAVEL:
            RAISED &
            LOWERED                                    CAPACITY:
            HEIGHT
                                                       PRODUCT INFORMATION
                                                       CIRCLE ONE OR MORE:
                                                         BASKET        PALLET      GAYLORD          OTHER
                                                       IF OTHER, PLEASE DESCRIBE:


                       FRAME
                      LENGTH             FRAME             LENGTH:                     WIDTH:
                                         WIDTH              HEIGHT:                 DIAMETER:
                                                       SPECIAL COLOR / PAINT (WATER-BASED ENAMEL STANDARD)

                                                      “RAL” NO:                               COLOR:
                                                      MANUFACTURER:                    TYPE OF COATING:
             POWER (460V, 3 PHASE STANDARD) IF CUSTOM, INDICATE BELOW   OPTIONS (CHECK ALL THAT APPLY)
             _____ A/C (110V _____ 220V _____ 460V (STD.) _____ OTHER _____)           ___ CHAIN GATES
             _____ SINGLE PHASE  _____ THREE PHASE (STD.)               ___ HANDRAILS W/ TOEBOARDS
             _____ ROTARY AIR / HYDRAULIC (80 CFM @ 80 PSI, 1/2 GPM)    ___ BRIDGE PLATE W/ CURBS
             _____ AIRBAG                                               ___ CONVEYOR ROLLER DIAMETER & CENTERS
             _____ WASH-DOWN                                            ___ ROTATE OPTION  ___ BALL TRANSFER TOP
                                                                                             (2,000 LB. MAX. CAPACITY)
             _____ UL OR CSA APPROVED ELECTRICAL COMPONENTS             ___ ACCORDION SKIRT
             _____ NO POWER UNIT (TOEGUARDS & UPPER TRAVEL LIMIT SWITCH INCLUDED)  ___ SURFACE MOUNT  ___ MANUAL TURNTABLE
             _____ NO POWER UNIT OR CONTROLS                            ___ PIT MOUNT     ___ FORK POCKET SUBFRAME
             CONTROLS:     _____ HAND (STD)      _____ FOOT             ___ SCALE - CAPACITY / SIZE (NTEP NOT AVAILABLE)
                                                                        ___  PORTABLE (PST - 12V DC STANDARD
             POWER UNIT:   _____ EXTERNAL       _____ INTERNAL (STD MOST MODELS)
                                                                        ___ POWER TRACTION DRIVE SYSTEM (PTDS - 24V DC)
             IF EXTERNAL, LENGTH OF CORDS (8’ STD):
                                                                        ___ SEMI-PORTABLE
             IF ANY OTHER SPECIAL POWER OR
             CONTROLS ARE REQUIRED, PLEASE INDICATE:                    ___ INTERNATIONAL SHIPPING, ISBM-15 CRATE
             APPLICATION INFORMATION
             DUTY CYCLE:              STARTS PER HOUR:           HOURS PER SHIFT:
                                       SHIFTS PER DAY:            DAYS PER WEEK:
                                            INDEXING:                 INCREMENT:
                      DUTY CYCLE IS CALCULATED BY STARTS PER HOUR OR NUMBER OF TIMES “UP”  BUTTON IS PUSHED.
                                ANTICIPATED CYCLE TIME:
                   SPECIAL TEMPERATURE REQUIREMENTS:
                         IS THIS A HAZARDOUS LOCATION?   IF YES:      CLASS: _______ DIV: _______ GROUP: ________
             OTHER SPECIAL REQUESTS OR APPLICATION INFORMATION:
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