PASSION FOR PROTECTION
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Date
Company name
Equipment brand
Equipment type
Contact person
Email
Phone number
Customer/project
Details Cabin fittedUser indoorUser outdoor
Operator language Choose oneEnglishDutchGermanDanishSwedishPolishSpanishFrench
Ambient temperature (°C)
Environment Zone 1Zone 2 (Active: including gas detection)Zone 2 (Passive: without gas detection)
Temperature class T1 450°CT2 300°CT3 200°CT4 135°CT5 100°CT6 85°C
Gas group Group IIB (also applicable for IIA)Group IIB+H²Group IIC
Environment Zone 21Zone 22
Cloud Ignition (°C)
Dust Layer Ignition (°C)
Dust group¹ Group IIIB (also apllicable for IIIA)Group IIIC
¹ If the temperature and dust groups are not provided, Mitrex will use a maximum surface temperature of 130°C for combustible dust (IIIB).
Traction motor ACDC
Pump motor ACDC
Steering motor ACDC
Other
ACDC Motor
Battery order from Mitrex YesNo
If yes
Voltage (V)
Capacity (Ah)
Size (LxWxH in millimeters)
Spare battery
YesNo
PLEASE NOTE: BATTERY CHARGE/CHANGE MUST BE DONE IN A NON-HAZARDOUS AREA!
Engine brand
Engine model
Turbo YesNo
If yes Water cooledAir cooled
Cylinders 46
Emissions control DPFEGR
If a diesel particulate filter (DPF), exhaust gas recirculation (EGR) or a catalytic converter is fitted to the machine, a full engineering assessment must be carried out before a quotation can be provided which will carry a charge. When the turbo is an air-cooled type, a full engineering assessment must be carried out.
The above statements have been read and understood
Work light frontBlinkers front (left & right)Work light rearRisk analyse per LED work light *Combination lights rear drive/brake/indicator (set)Flashing beaconModification bluespotBack-up buzzerElectric claxonModification standard electric wiper frontModification standard electric wiper rearDelivery and modification of an electric wiperDelivery and mounting of a hand wiperModification standard heaterDelivery and modification of a heaterAntistatic seat/arm rest**Antistatic tires (forklifts)***Antistatic wheels (stacker, pallet- and reach trucks)***Modification brush to antistatic
Other, such as
Work light front amount
Work light rear amount
Risk analyse per LED work light amount
Modification bluespot amount
Front size
Rear size
Antistatic wheels load wheel
Antistatic wheels castor wheel
Antistatic wheels traction wheel
Modification brush to antistatic load wheel amount
* remark: Only applied for Zone 2/22 & if it is in a metal enclosure
** remark: For all the Zones(1, 21, 2, 22) the seat/arm rest must be antistatic. In case you as a customer take care of this option, the seat must be antistatic upon the delivery of the machine to our workshop.
*** remark: In case the machine drives faster than 6 km/h, all the wheels/tires must be antistatic.