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Distributor Information
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Date:
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*
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Link-Seal Distributor:
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*
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Requested By:
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*
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Contractor Name:
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Telephone:
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*
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e-mail:
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*
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Job Name:
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Project Information
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Link-SealŪ Model:
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LS-200
LS-275
LS-300
LS-315
LS-325
LS-340
LS-360
LS-400
LS-410
LS-425
LS-475
LS-500
LS-525
LS-575
LS-600
LS-650
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Number of Links:
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Measured Pipe
Circumference:
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*
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Type of Pipe:
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*
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Is Pipe Coated?
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Yes
No
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Type of Hole:
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Model WS Sleeve
Model CS Sleeve
Model CC Disks
Steel Sleeve
PVC Sleeve
Cored Hole
Other
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Hole Diameter:
OR
WS/CS/CC Model:
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*
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Is Pipe Centered?
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Yes
No
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Is Pipe Supported?
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Yes
No
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Please include annular space measurements (in inches) at locations shown below.
(Annular space is the distance between the pipe O.D. and penetration I.D.)
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Position #LS12
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Position #LS11
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Position #LS02
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Position #LS09
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Position #LS03
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Position #LS08
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Position #LS05
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Position #LS06
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