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					                                 производство промышленного оборуд ования
                                 115404, Москва, 1-я Стекольная ул., д.7 стр.3
                                 Tel/fax: +74959842950, www.yatagan.ru e-mail: info@yatagan.ru

Re f .№_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                       To ______________________ ___
Dat e «_ _ _ » _ _ _ _ _ _ _ _ _ _ _ _ _ 2 0 0 _ _ г.                        _____________________________

                                                        QUESTIONNAIRE
                                     assortment (application for design) «Gasconverter «Yatagan»

        1. Information about Customer:
           Organization name ______________________________________________
           Profile status __________________________________________________
        2. Information about middleman (assembling/installation organization):
           Organization name ______________________________________________
           Contact information ____________________________________________
        _____________________________________________________________________
        3. Information for assortment (design)
           Type of pollutions (name):
        _____________________________________________________________________
           __________________________________________________________________
        3.2. Solid phase, dust, fibers, bonding agent (mg/m3)
             _________________________________________________________________
        _____________________________________________________________________
        3.3. Air volume that should be purified (m3/h) ____________________________________
        3.4. Temperature of purified air (оС)____________________________________________
        3.5. Emission purification, apartment cleaning, surge, recirculation____________________
        3.6. Total contents of pollution component in purified air, mg/m3
        _____________________________________________________________________
        3.7. Purification entering air: under pressure, under depression
        3.8. Required operating mode: continuous; short-time
        3.9. Your needs designed ; or just procurement 
        3.10. Methods of air purification till present moment ________________________________
        3.11. The date of planned order on equipment ______________________________
        3.12. Required delivery terms __________________________________________
        3.13. Nearness residential area ______________________________________________
        3.14. Note (direction control, local drawing out, require dimensions, etc.)
        _____________________________________________________________________
           __________________________________________________________________
           _________________________________________________________


                                                                             «____»____________2009 г.
       Yours sincerely
     Trade department manager                                                    Barchukov Konstantin
     Tel/fax (495)984-29-50,
     e-mail: info@yatagan.ru