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Section I
1. Boiler manufactured by
(Name and address of Manufacturer)
, P-7 ID No.
3. Location of installation
(Name and address)
4. Unit identification
(Complete boiler, superheater, waterwall, economizer, etc.)
ID Nos.
(Mfrs. Serial No.) (CRN) (Drawing No.) (Natl. Board No.)
Qty.
Size
* Material: (1) SA-216, WCB. (2) SA-217, WC6. (3) SA-217, WC9. (4) SA-182, F 22. (5) Other ** Connector type: (A) Groove Weld. (B) Socket Weld. (C) Threaded. (D) Flanged.
12/96
This Form (E00129) may be obtained from the Order Dept., ASME, 22 Law Drive, Box 2300, Fairfield, NJ 07007
CERTIFICATE OF COMPLIANCE We certify the statements in this Manufacturers Data Report for Safety Valves to be correct and that all details conform to Section I of the ASME BOILER AND PRESSURE VESSEL CODE. Our Certificate of Authorization No. Date Signed to use the (S) or (M) Name Symbol expires .
(Authorized Representative)
(Manufacturer)