FORM U-4 MANUFACTURER’S DATA REPORT SUPPLEMENTARY … · 2019-02-27 · FORM U-4 MANUFACTURER’S...
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FORM U-4 MANUFACTURER’S DATA REPORT SUPPLEMENTARY SHEET As Required by the Provisions of the ASME Boiler and Pressure Vessel Code Rules, Section VIII, Division 1 Date (Authorized Inspector) [National Board (incl. endorsements)] Name Commissions Date (Manufacturer) (Representative) Name Signed Certificate of Authorization: Type No. Expires Data Report Item Number Remarks (08/14) 1. Manufactured and certified by (Name and address of Manufacturer) 2. Manufactured for (Name and address of Purchaser) 3. Location of installation (Name and address) 4. Type (Horizontal, vertical, or sphere) (Tank, separator, heat exch., etc.) (Manufacturer’s serial number) (CRN) (Drawing number) (Year built) (National Board number)
Transcript of FORM U-4 MANUFACTURER’S DATA REPORT SUPPLEMENTARY … · 2019-02-27 · FORM U-4 MANUFACTURER’S...
FORM U-4 MANUFACTURER’S DATA REPORT SUPPLEMENTARY SHEETAs Required by the Provisions of the ASME Boiler and Pressure Vessel Code Rules, Section VIII, Division 1
Date(Authorized Inspector) [National Board (incl. endorsements)]
Name Commissions
Date(Manufacturer) (Representative)
Name Signed
Certificate of Authorization: Type No. Expires
Data ReportItem Number Remarks
(08/14)
1. Manufactured and certified by
(Name and address of Manufacturer)
2. Manufactured for(Name and address of Purchaser)
3. Location of installation(Name and address)
4. Type(Horizontal, vertical, or sphere) (Tank, separator, heat exch., etc.) (Manufacturer’s serial number)
(CRN) (Drawing number) (Year built)(National Board number)
