FORM A-1
MANUFACTURER’S DATA REPORT Page of
FOR PRESSURE VESSELS
As Required by the Provisions of the ASME Code Rules, Section VIII, Division 2
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
Horiz. or vert. tank Mfr.’s serial no. CRN Drawing no. Nat'l. Bd. no. Year built
5. The chemical and physical properties of all parts meet the requirements of material specifications of the ASME BOILER AND PRESSURE
VESSEL CODE. The design, construction, and workmanship conform to ASME Code, Section VIII, Division 2.
Year Class Code case no.
Items 6 to 11 incl. to be completed for single wall vessels, jackets of jacketed vessels, or shells of heat exchangers
6. Shell
Material (spec. no., grade) Nom. thk. Corr. allow. Diameter Length (overall)
7. Seams
Longitudinal Heat treatment Nondestructive examination
Girth Heat treatment Nondestructive examination No. of courses
8. Heads: (a) Matl. (b) Matl.
Spec. no., grade Spec. no., grade
Location Minimum Corrosion Crown Knuckle Elliptical Conical Apex Hemispherical Flat Diameter Side to Pressure
(Top, Bottom, End) Thickness Allowance Radius Radius Ratio Angle Radius (Convex or Concave)
(a)
(b)
9. If removable, bolts used (describe other fastenings):
Matl. spec. no., grade, size, number
10. Jacket closure If bar, give dimensions . If bolted, describe or sketch.
Describe as ogee and weld, bar, etc.
11. MAWP at max. temp. Min. design metal temp. at
(Internal) (External) (Internal) (External)
Impact test At test temperature of
Hydro., pneu., or comb test pressure
Items 12 and 13 to be completed for tube sections
12. Tubesheets
Stationary matl. (spec. no., Diam. (subject to pressure) Nom. thk. Corr. allow. Attach. (wld., bolted)
grade)
Floating matl. (spec. no., (Diam.) Nom. thk. Corr. allow. Attach. (wld., bolted)
grade)
13. Tubes
Matl. (spec. no., grade) O.D. Nom. thk. Number Type (straight or "U")
Items 14 to 18 incl. to be completed for inner chambers of jacketed vessels, or channels of heat exchangers
14. Shell
Material (spec. no., grade) Nom. thk. Corr. allow. Diameter Length (overall)
15. Seams
Longitudinal Heat treatment Nondestructive examination
Girth Heat treatment Nondestructive examination No. of courses
16. Heads: (a) Matl. (b) Matl.
Spec. no., grade Spec. no., grade
Location Minimum Corrosion Crown Radius Knuckle Elliptical Conical Apex Hemispherical Flat Diameter Side to Pressure
(Top, Bottom, End) Thickness Allowance Radius Ratio Angle Radius (Convex or Concave)
(a)
(b)
17. If removable, bolts used (describe other fastenings):
Matl. spec. no., grade, size, number
18. MAWP at max. temp. Min. design metal temp. at
(Internal) (External) (Internal) (External)
Impact test At test temperature of
Hydro., pneu., or comb test pressure
(07/17)
FORM A-1 Page of
Manufactured by
Manufacturer’s Serial No. CRN National Board No.
Items below to be completed for all vessels where applicable.
19. Nozzles inspection and safety valve openings
Purpose No. Diam. or Size Type Material Nom. Thk. Reinforcement Material How Attached Location
(lnlet, Outlet, Drain, etc.)
20. Body Flanges
Body Flanges on Shells
Bolting
Washer
No. Type ID OD Flange Thk Min Hub Thk Material How Attached Location Num & Size Bolting Material (OD, ID, thk) Washer Material
Body Flanges on Heads
Bolting
Washer
No. Type ID OD Flange Thk Min Hub Thk Material How Attached Location Num & Size Bolting Material (OD, ID, thk) Washer Material
21. Support Skirt Lugs Legs Other Attached
Yes or no No. No. Describe Where and how
22. Service: Fatigue analysis required and
Yes or no Describe contents or service
Remarks:
CERTIFICATION OF DESIGN
User’s Design Specification on file at
Manufacturer’s Design Report on file at
User’s Design Specification certified by PE State Reg. No.
Manufacturer’s Design Report certified by PE State Reg. No.
CERTIFICATE OF SHOP COMPLIANCE
We certify that the statements in this report are correct and that all details of design, material, construction, and workmanship of this
vessel conform to the ASME Code for Pressure Vessels, Section VIII, Division 2.
“U2” Certificate of Authorization No. expires
Date Co. name Signed
Manufacturer Representative
CERTIFICATE OF SHOP INSPECTION
Vessel made by at
I, the undersigned, holding a valid commission issued by the National Board of Boiler and Pressure Vessel Inspectors and employed by
of ,
have inspected the pressure vessel described in this Manufacturer’s Data Report on ,
and state that, to the best of my knowledge and belief, the Manufacturer has constructed this pressure vessel in accordance with ASME Code,
Section VIII, Division 2. By signing this certificate neither the Inspector nor his employer makes any warranty, expressed or implied,
concerning the pressure vessel described in this Manufacturer’s’ Data Report. Furthermore, neither the Inspector nor his employer shall be
liable in any manner for any personal injury or property damage or a loss of any kind arising from or connected with this inspection.
Date Signed Commissions
Authorized Inspector National Board Authorized Inspector Commission number
(07/17)
FORM A-1 Page of
Manufactured by
Manufacturer’s Serial No. CRN National Board No.
CERTIFICATE OF FIELD ASSEMBLY COMPLIANCE
We certify that the field assembly construction of all parts of this vessel conforms with the requirements of Section VIII, Division 2
of the ASME BOILER AND PRESSURE VESSEL CODE.
“U2” Certificate of Authorization No. expires
Date Co. name Signed
Assembler that certified and constructed field assembly Representative
CERTIFICATE OF FIELD ASSEMBLY INSPECTION
I, the undersigned, holding a valid commission issued by the National Board of Boiler and Pressure Vessel Inspectors and employed by
of
have compared the statements in this Manufacturer’s Data Report with the described pressure vessel and state that parts referred to as
data items
not included in the certificate of shop inspection, have been inspected by me and that, to the best of my knowledge and belief, the
.
Manufacturer has constructed and assembled this pressure vessel in accordance with the ASME Code, Section VIII, Division 2.
The described vessel was inspected and subjected to a hydrostatic test of .
By signing this certificate neither the Inspector nor his employer makes any warranty, expressed or implied, concerning the pressure
vessel described in this Manufacturer’s Data Report. Furthermore, neither the Inspector nor his employer shall be liable in any manner
for any personal injury or property damage or a loss of any kind arising from or connected with this inspection.
Date Signed Commissions
Authorized Inspector National Board Authorized Inspector Commission number
(07/17)
