Form A 1 – Fill Out and Use This PDF

FORM A-1 MANUFACTURER’S DATA REPORT 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

Addenda date

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.DiameterLength (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)

(07/10)

FORM A-1 (Back)

Items below to be completed for all vessels where applicable. 19. Nozzles inspection and safety valve openings

20. Support Skirt

Lugs

Legs

Other

Attached

Yes or no

No.

No.

Describe

Where and how

21. Service: Fatigue analysis required

and

Yes or no

Describe contents or service

Remarks:

CERTIFICATION OF DESIGN

Users 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 conforms 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

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		Nat’I. Board (incl. Endorsements), State, Prov., and 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/or the State or

Province of

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		Nat’I. Board (incl. Endorsements), State, Prov., and No.

(07/10)