Purco2 Cleaning Technologies Questionnaire

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General Information
Company Name
Contact Name
Email Address
Street Address
City
State/Province
Zip Code
Telephone Number
Fax Number

Product Information

Name of Product
Use/Purpose
Length	Width Height Diameter
Unit Weight	Materials of Construction

Process Information

Is your product cleaned in a cleanroom/controlled environment?	Specify:
How is your product currently cleaned?
What are your current cleaning steps?
Step 1
Step 2
Step 3
Step 4
Cleaning Solvents used:
Cleaning fluid temperature:
Type of energy used:

Contaminates and Cleaning Requirements

List all known/measures surface contaminants:
Source of contamination:

Production Cleaning Information

How many parts required?	per day per month per year
How many different parts will be cleaned?
Do they all have the same contaminates?	yes no
Is there any reason you are aware of that prevents them from being cleaned together?	please explain:

Post Cleaning Surface Treatment Requirements (Plasma Treatments)

Describe any post-cleaning surface modification required for bonding, coating, dispensing, etc.

Inspection/Surface Treatment Verification

Cleanliness test methods/equipment:
Is inspection 100%	yes no
Based on sampling plan?	Explain:

Additional Information

Are there any special cleaning challenges such as soft coatings, machining chips, blind holes, etc.? Please describe:

Drawings or Pictures

Please include a drawing, sketch or picture (.jpg or .bmp) of the product to be evaluated: