Customer Application Information
This information is required to properly configure a sensor system to meet your hydrogen detection and/or measurement needs.
Return completed form to: Fax: (661) 775-9515 or Email: sales@h2scan.com
Customer Information
Contact Name:
Company Name:
Street:
City:
Country:
Phone:
Purchase Order No.:
Title:
End Application:
Date:
State:
Email:
Fax:
Date Needed:
Zip:
H2scan Quote#:
Basic Information - Items in Blue are required
HY-ALERTA™ 2600 Explosion Proof Area Hydrogen Monitor Configuration
Monitor Configuration
Optional
Equipment
Analog Output
Serial Interface
USB Adapter
RS-232
RS-422
Yes
4-20mA
Interconnect
Communication Cable
Analog Scale
0-4% Default
Low
%H2
High
No
Length
(max 150’)
%H2
Set Points, %H2
Alert Relay
Default: 1%
Alarm Relay
Default: 2%
Gas Composition: It is critical that ALL elements present in the gas mixture be listed. All non-listed gases may
affect the warranty of the analyzer. If any gas composition changes beyond the specified range, analyzer performance
may be impacted. Contact H2scan with an updated CAI..
Background Gas:
Air  Other
Gas Components
Ranges at 1 ATM or Other
Min
(If background gas is NOT Air, then Oxygen and Nitrogen concentrations MUST BE specified below.)
%
ppm
%
%
%
ppm
ppm
ppm
Inert Gases (He, Ar, etc.)
%
ppm
Carbon Dioxide, CO2
Alkanes (Propane, Methane, etc.)
%
ppm
Carbon Monoxide, CO
%
%
%
ppm
ppm
ppm
Hydrogen Sulfide, H2S
%
ppm
Other:
%
ppm
Hydrogen, H2
Is Hydrogen Always Present?
Nitrogen, N2
Oxygen, O2
Water Vapor, H2O
Comments
Concentrations
Max Nominal
Units
Yes
Alkenes (Acetelyne, Ethene, etc.)
73000006 R2, Customer Application Information, Model 2600
No
%RH
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This H2scan Corporation disclaimer covers the validity of quotes based on information provided by
the customer on the Customer Application Information form. This customer provided information is
used by H2scan to properly configure products that we warrant for the customer application. H2scan
disclaims responsibility for any action taken in reliance upon customer provided information. All
quotes from H2scan are valid for 60 days following the date of email transmission. Our company
accepts no liability for the content of this email, or for the consequences of any actions taken on the
basis of the information provided, unless that information is subsequently confirmed in writing. Any
views or opinions presented in this email are solely those of the author and do not necessarily
represent those of the company. Finally, the recipient should check this email and any attachments
for the presence of viruses. The company accepts no liability for any damage caused by any virus
transmitted by this email.
H2scan Corporation, 27215 Turnberry Lane, Unit# A, Valencia, CA, 91355 USA, www.H2scan.com
73000006 R2, Customer Application Information, Model 2600
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