FORM G-2 GC OR GRAPHITE QUALITY SYSTEM CERTIFICATE … · (07/17) FORM G-2 GC OR GRAPHITE QUALITY...
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(07/17) FORM G-2 GC OR GRAPHITE QUALITY SYSTEM CERTIFICATE HOLDER’S DATA REPORT FOR MACHINED GRAPHITE CORE COMPONENTS* As Required by the Provisions of the ASME Code, Section III, Division 5 Pg. 1 of 1. Machined and certified by 2. Manufactured for 3. Location of installation Type 4. 5. ASME Code, Section III, Division 5 6. Remarks 7. When applicable, GC or Graphite Quality System Certificate Holder’s Data Reports or GMO’s Reports are attached for each Graphite Core Component listed in this report. (name and address of GC or Graphite Quality System Certificate Holder) (edition/date) [Addenda (if applicable)] (date) (Code Case no.) (Class) (name and address of purchaser) (name and address) (core design type) (material spec. no.) (year built) Graphite Core Component Identification (Serial) No. Graphite Core Component Material Traceability Code Graphite Core Component Identification (Serial) No. Graphite Core Component Material Traceability Code 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 * Supplemental information in the form of lists, sketches, or drawings may be used provided: (1) size is 8 1 /2 11 or A4; (2) information in items 2 and 3 on this Data Report is included on each sheet; and (3) each sheet is numbered and the number of sheets is recorded at the top of this form.
Transcript of FORM G-2 GC OR GRAPHITE QUALITY SYSTEM CERTIFICATE … · (07/17) FORM G-2 GC OR GRAPHITE QUALITY...
(07/17)
FORM G-2 GC OR GRAPHITE QUALITY SYSTEM CERTIFICATE HOLDER’S DATA REPORT FORMACHINED GRAPHITE CORE COMPONENTS*
As Required by the Provisions of the ASME Code, Section III, Division 5 Pg. 1 of
1. Machined and certified by
2. Manufactured for
3. Location of installation
Type4.
5. ASME Code, Section III, Division 5
6. Remarks
7. When applicable, GC or Graphite Quality System Certificate Holder’s Data Reports or GMO’s Reports are attached for each Graphite Core Componentlisted in this report.
(name and address of GC or Graphite Quality System Certificate Holder)
(edition/date) [Addenda (if applicable)] (date) (Code Case no.) (Class)
(name and address of purchaser)
(name and address)
(core design type) (material spec. no.) (year built)
Graphite Core ComponentIdentification (Serial) No.
Graphite Core ComponentMaterial Traceability Code
Graphite Core ComponentIdentification (Serial) No.
Graphite Core ComponentMaterial Traceability Code
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* Supplemental information in the form of lists, sketches, or drawings may be used provided: (1) size is 81/2 � 11 or A4; (2) information in items 2 and 3 on this DataReport is included on each sheet; and (3) each sheet is numbered and the number of sheets is recorded at the top of this form.
GC or GRAPHITE QUALITY SYSTEM CERTIFICATE OF COMPLIANCE
CERTIFICATE OF INSPECTION
Date Signed Commission[Authorized Nuclear Inspector (Graphite)] [National Board Number and Endorsement]
Date Name Signed
We certify that the statements made in this report are correct and that the Graphite Core Component(s) listed in this report conform(s) to the rules for construction of the ASME Code, Section III, Division 5.
GC Certificate of Authorization or Graphite Quality System Certificate No. Expires
(GC or Graphite Quality System Certificate Holder) (authorized representative)
(07/17)
I, the undersigned, holding a valid commission issued by the National Board of Boiler and Pressure Vessel Inspectors and employed by of have inspected these items described in this Data Report on , and state that to the best of my knowledge and belief, the Certificate Holder has machined these Graphite Core Components in accordance with the ASME Code, Section III, Division 5.By signing this certificate neither the inspector nor his employer makes any warranty, expressed or implied, concerning the equipment described in this Data Report. Furthermore, neither the inspector nor his employer shall be liable in any manner for any personal injury or property damage or loss of any kind arising from or connected with this inspection.
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