1.TYPE OF APPLICATION

  A. Equipment the Kerry Actuator is to operate: 
      (flop gate, slide gate, butterfly valve, damper, carriage, side guides, etc) 
      Size of device: 

2. PHYSICAL DATA

  A. Force req.: 
       Pounds push: 
       Pounds pull: 

  B. Stroke (in inches): 

  C. Speed or duration of movement (inches/sec) 
       Extend speed: 
       Retract speed: 

  D. Total time for one stroke (seconds) 
       Extend time: 
       Retract time: 

  E. Negative Load (please choose one) 
       No    Yes 
       If Yes: 
       Extend: 
       Retract: 

  F. Orientation of Unit 
       Horiz.   Vert. 
       If Vertical then choose:  Rod Up    Rod Down 

3. FREQUENCY OF MOVEMENTS

     Number of complete cycles 
       Per Hour:    Per Day: 

4. ABSOLUTE LOCK IN POSITION

     No    Yes        Duration: 

5. MOUNTING

     Rod End: 
       Male Clevis    Threaded     Female Clevis     Spherical eye 
       Other (specify): 

     Body Mount By: 
        Trunnion     Foot     Eye to eye     Front Flange 
        Other (specify): 

6. POWER SUPPLY

      Voltage:     Frequency: 
      Phases:      Enclosure: 

7. SURROUNDING CONDITIONS

      Outdoor     Indoor 
      Shocks/vibrations:  mild     moderate     severe     none 

8. ACCESSORIES

     Please check any that apply 

Trunnion Brackets 
Limit Switch______No. positions:       No. contacts: 
Position Feedback_____ Type: 
Accumulator (if fail safe)_____Extend:     Retract: 
MPO-1Q Manual Pump        Built in:      Detachable: 
PC-501 Position Controller 
Motor Starter Panel ____  Elec. const. 
Position Indicator 
Other: 

9. ADDITIONAL COMMENTS