Modular Clean Room Worksheet

Please fill out this form as completely as possible so that we are better able to help you. If you need help with this form or prefer to discuss your clean room needs directly with us, call 1-800-815-2726. This information is used only to contact you and will not be sold or redistributed.

General Information
Type of process you will be doing in clean room.
Which cleanliness classification will you need?
Clean room dimensions (in feet and inches) (specify up to 3 room dimensions)	(W x L x H) (W x L x H) (W x L x H)
Will you need a separate gowning room?	Yes No

Temperature and Humidity Requirements
Clean room temperature requirement? Clean room humidity requirement?	to degrees to percent
Expected temperature outside clean room? Expected humidity outside clean room?	to degrees to percent
Describe any special exhaust requirements.
List any excessive heat producing equipment. (in BTUs or KW)

Electrical Requirements
Which electrical service will be available for the modular clean room?	208-230 single phase 208-230 three phase 460 three phase Not Sure
How many amps will be needed inside?	Not sure
How many electrical outlets inside?	Not sure
Any special lighting requirements?

Special Equipment
Will the modular clean room require any special equipment? (check all that apply)	Water Purification System Laminar Flow Hood Sinks Process Piping Gowning Equipment
Any other special equipment requirements?

Contact information
Please include your name and at least one way for us to contact you. Or, print this worksheet, fill it in and fax it to 972-513-1877. This information is used only to contact you and will not be sold or redistributed.
Full Name
Phone Number
E-mail Address
Fax Number

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