

| Subject: | Head Survey Form -- Last Draft |
| From: | Steven X. Schwenk |
| Date: | Wed, 8 Apr 1998 22:48:04 -0700 |
Here is the Proposed survey form. Please send me any
comments/suggestions/flames, etc. directly.
I will post the survey form for everyone to complete... once on Friday
and once next Wednesday. All you will need to do is hit reply, fill in
the answers and send it back to me (or just delete it). The form below
is filled out for my van, as an example. It took me just under 2
minutes to complete it.
Steve
90 Year of Vehicle
6 Model: Van (1) Wkendr. (2) Westy (3) Sync (4) Sync
Wkedr (5) Sync Westy (6)
94k Current Mileage
0 Mileage When Leaks Appeared ("0" if no leaks)
0 Mileage When Head Gaskets Replaced ("0" if never
replaced")
0 Mileage When Gaskets "Failed" [Vehicle not
drivable)("0" if not apply)
0 Mileage when First Experienced Overheating Problems
("0" if never)
0 Mileage When Radiator Sealant Used ("0" if never)
0 Number of Times Sealant Used
0 Mileage When Sealant Stopped Working (separate for each
such event)
0 Type of Sealant : Ceramic (1) Aluminum (2) Prestone
(3) Basleak (4) Other (5)
4 Coolant Type : Phosphate (1) No Phosphate (2) VW (3)
Mix (4)
2 Water Type: Hard Tap (1) Soft Tap (2) Distilled (3)
de-ionized (4)
50 % of water used with coolant
1 Avg. Frequency of Coolant Change: yearly (1) every 2
yrs. (2) 3 yrs. (3), etc.
40 Average Low winter Temperature
85 Average High summer temperture (where van is driven)
1 Is the van garage Kept: Yes (1) No (2)
-------
1 Van Usage: Daily (1) Weekly (2) Monthly (3)
9k Average miles per year
2 Driving Type: Mostly town (1) mostly highway (2)
equal mix (3)
2 Driver Habits: Gentle (1) Average (2) Aggressive (3)
3 Short Trips of Ten Mins. or Less: Daily (1) Weekly
(2) Rarely (3)
3 Mins. warm vehicle Up before driving in winter
1 Mins. warm vehicle Up before driving in warmer (+50F.)
weather
1 Do you drive the van gently until it reaches temp:
Y(1)N(2)
2 Have You Augmented the Ground Wires at
Engine/Head/Frame: Yes (1) no (2)
1 Have you ever checked your ground wires: Yes (1) No
(2)
2 Have you ever found that your ground wires required
cleaning/mait. Y(1) N(2)
1 Does your van have rust: None (1) a little (2) some
(3) moderate (4) heavy (5)
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