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[null,null,null,null,null,null,"Chiller Nameplate (Oil & Ref) Information Form"]
[]
[null,"*Scheduled data collection date:",null,null,null,null,null,null,null,null,null,"/",null,"/",null,"Time:",null,null,":"]
[null,"   *NexGen Activity #:"]
[null,"*York Process System Startup?  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Fax to: 414-524-4336"]
[]
[null,"General Information                             "]
[null,"*Branch:",null,null,"DELMARVA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"*Branch #:",null,null,"0N28"]
[null,"*FLSP:",null,null,"KEVIN FRAZE",null,null,null,null,null,null,"^Employee ID:",null,null,null,1174842,null,null,"*Cell/Pgr #:",null,null,"302-353-0315"]
[null,"*Check analyses to be included in the Predictive Diagnostics Report:"]
[]
[]
[null,"Customer Information   ",null,null,null,null,null,null,"Does this customer exist in our database?  "]
[null,"*Customer Name / Site:",null,null,null,null,null,"DUPONT EXPERIMENTAL STATION"]
[null,"*Street Address:",null,null,null,"RT. 141 LANCASTER PIKE"]
[null,"*City, State, Zip:",null,null,null,"WILMINGTON, DE, 19880"]
[]
[null,"Machine Information",null,null,null,null,null,null,null,null,null,null,null,null,"CMMS Equipment ID: "]
[null,"*Machine Make:",null,null,null,"YORK",null,null,null,null,null,null,null,null,"Customer Ref #:"]
[null,"*Machine Full Model #:"]
[null,"*Machine S/N:",null,null,null,null,null,null,null,null,null,null,null,null,"*Warranty? ",null,null,null,null,null,null,"Exp:"]
[null,"Tonnage:",null,null,null,null,null,null,null,null,null,null,null,null,"  *On a VFD?    "]
[]
[null,"Compressor Information  ",null,null,null,null,null,null,null,"**Note if more than 1 compressor please fill out each on its own form."]
[null,"*Compr Model #:",null,null,null,null,null,null,null,null,null,null,null,null,"*Compr S/N:"]
[null,"*Compr Type:                                                                              ",null,null,null,null,null,null,null,null,null,null,null,null,null,null," **Don't collect vib data on scrolls or recips"]
[null,"*Speed Code/Gear Ratio:",null,null,null,null,null,null,null,null,null,null,null,null,null,"Hermetic?   "]
[]
[null,"Oil / Refrigerant Information",null,null,null,null,null,null,null,"SR / Activity / P.O. Number:"]
[null,null,null,null,null,null,null,null,null,"            (If different than number at top of form)"]
[]
[null,"^Sample Source:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"                "]
[null,"^System Condition:"]
[null,"^Chiller Duty:"]
[null,"^Heat transfer fluid:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"                             "]
[null,"*Refrigerant type:",null,null,null,null,null,null,null,"^Sample Date:",null,null,null,null,null,null,null,null,"^Sump Capacity: "]
[null,"^Ref temperature at time of sampling :",null,null,null,null,null,null,null,null,null,null,null,"*Sample State:"]
[null,"*Oil Type/Brand:",null,null,null,null,null,null,null,"^Sample Date:",null,null,null,null,null,null,null,null,"^Sump Capacity:"]
[null,"^Oil Mfg.:",null,null,null,null,null,null,null,"^Oil Grade:",null,null,null,null,null,null,null,"^Date of last oil change:"]
[]
[null,"Motor Information ",null,null,null,null,null,"(This information NOT needed for Oil / Refrigerant processing)"]
[null,"*Motor Make:",null,null,null,null,null,null,null,null,null,null,null,"Motor Model:"]
[null,"*Motor S/N:"]
[null,"*Volts:",null,null,null,null,null,"*HP:",null,null,null,null,null,"*Hertz:",null,null,null,null,"*RPM:"]
[null,"*RLA/FLA:",null,null,null,null,null,null,null,"LRA Delta:",null,null,null,null,null,null,null,null,"LRA Y:"]
[null,"Type:",null,null,null,null,null,null,null,"Frame:",null,null,null,null,null,null,null,null,"Design:"]
[null,"SF:",null,null,null,null,null,null,null,"Form:",null,null,null,null,null,null,null,null,"Code/KVA:"]
[null,"Shaft End Bearing:",null,null,null,null,null,null,null,null,null,null,null,"Open End Bearing:"]
[null,"* Required Fields for Predictive route",null,null,null,null,null,null,null,null,"* & ^ Required fields for Oil/Ref samples",null,null,null,null,null,null,null,null,null,null,"Rev. 5/18/2011"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"Instructions:"]
[null,"The purpose of having everything on this form is to save you from filling out multiple forms for more than one Predictive Service performed on a machine."]
[]
[null,"1. To have a Predictive vibration route created:                                                     --Fill out this form. The asterisked marked fields (*) must be filled in before a route can be created."]
[null,"(Fax the completed form to (414) 524-4336 OR email it to predictive.diagnostic.team@jci.com. If you have any questions please contact us @ 1-414-524-5000, selecting 6, then 1, 1 again and 5 as your options.)"]
[]
[]
[null,"2. To send in an oil and/or refrigerant sample:\n  --You must fill out this form and include a copy with every sample. (both (*) marked fields and the (^) marked fields are required except motor information)\n  --Please write legibly so that every new sample can be \n            correctly trended with any previous samples.\n  --This form does not replace the oil sample bottle label or\n            the refrigerant tag.  Labels and tags must still be filled out \n            and attached to the samples."]