Engine Thermostat Questionnaire

Caltherm Corporation

Company Name: _______________________________________________    Address:______________________________________________________

Telephone/Fax:_________________________________________________

Company Contact:______________________________________________

_____________________________________________________________

Application Description:

_____________________________________________________________

_____________________________________________________________

Anticipated annual usage:               ____________

Calibration:

          Start to Open Temperature:  _______ @ RPM

          Full Open Temperature:       _______  @RPM

Fluid Loading on T'stat - Engine Speed, Flow and Pressure:

                             Engine Speed          Max Flow            Max Delta P

                             W/ Stat Open          w/ Stat Closed          w/ Stat Closed

                             RPM                              GPM                            PSID

Idle speed:             _____                           _____                           _____

Peak Torque:         _____                           _____                           _____

High Idle:               _____                           _____                           _____

Max Operating

Speed:                   _____                           _____                           _____

Max Verification

Test Speed:           _____                           _____                           _____

Minimum Flow and Maximum Pressure requirements

          Minimum full-open time response requirement:  ______________

          Maximum full-open pressure drop allowed: ______________

Time response

          Start-to-open to full-open time response: __________ Sec./Min.

          Full-open to start-to-open time response: _________ Sec./Min.

Maximum Operating Temperature:  _______ F or ______C

Max Over-temperature: __________ F or_______ C

Number of blades on pump impeller: ________

          Gear or Belt Driven: ________

Coolant

          Fluid medium: _____________________

          Additives:  ________________________________

          Fill rate during engine assembly: _________________

          Pressure during fill: ______________

Outlet Housing Separate or Integrated:

          Material Requirements (Metal or Plastic):

Thermostat Orientation in Engine (Horizontal, Vertical, Other):

Electrical Operation: _______________________________________________

Venting Devices

          Jiggle Pin: ___________

          Ball Valve: ____________

          Hole: ____________

          Notch in Seat or Valve: _____________

          Vent on Outlet Connector: _____________

          Independent Vent: ____________

Leakage requirements: ____________

          Flange Seal: ___________

          Rubber Valves: ___________

          Locktite: ____________

Gasket Style

          Flat Gasket: __________

          O-ring: ___________

          U-Seal: __________

Main Valve Style:

          Sleeve: ____________

Reverse Poppet: ____________

          Metal:  _____

          Soft:     _____

Pilot:    _____

Bypass Poppet Required: ________________

Bypass Poppet Valve Style: ____________

          Rubber Coated: ____________

          Spring Loaded vs. Stationary: _____________

          Weld vs. Press Fit: ______________

Bridge Type: _______________

          Std: _____________

          Button: ______________

          Crimped Piston: _______________

Thermostat Normally Open or Normally Closed:  _____

Dimensional Limitations:  _____

Qualification Requirements:  _____

Duty Cycle: ____________

Life Requirements/Service Interval: ___________________________

Element Type: __________________

          Flat Diaphragm: _______________

          Squeeze-Push: ____________

Please copy and mail or fax completed questionnaire to Caltherm address below.

Caltherm Corporation

910 S Gladstone Ave

Columbus, IN 47201

(812) 372-0281 * FAX (812) 376-8305