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 6-11 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. (in.) Corr. allow. (in.) Inside diameter (ft & in.) length (overall)(ft & in.)
7.
Seams
Longitudinal Heat treatment Radiographic treatment

Girth Heat treatment Radiographic treatment No. of courses

8. Heads: (a) (b)

Matl. Matl.
Spec. No., Grade Spec. No., Grade

Location
(Top, Bottom, Minimum Corrosion Knuckle Elliptical Conical Hemispherical Flat Side to Pressure
Ends) Thickness Allowance Radius Ratio Apex Angle Radius Diameter (convex or concave)
(a)
(b)
9. If removable, bolts used (describe other
fastenings)
(Mat’l Spec. No., Grade, Size, No.)

10. Jacket If bar, give If bolted, describe or sketch

closure dimensions
Describe as ogee and weld, bar,
etc.

11. Design psi at max °F Charpy ft -lb

Press. temp. Impact
at test temp. °F, Min. design metal ° F at psi. Pneu., hydro, or comb.
of temp.
test psi.
pressure
Items 12 and 13 to be completed for tube sections.
12.
Tubesheets
Stationary (Mat’l Spec. No. Diam, In. (subject to Nom. thk., in. Corr. Allow., (in.) Attach. wld, bolted
Grade) pressure.)

Floating (Mat’l Spec. No.) (Diam., in.) Nom. thk., in. Corr. Allow., (in.) Attach. wld, bolted
13.
Tubes
Mat’ (Spec. No., Grade ) O.D.,( in.) Nom. thk.( in. or gage) Number Type (Straight or U)

Items 14-18 incl. To be completed for inner chambers of jacketed vessels or channels of heat exchangers.
14. Shell
Material (Spec. No, Grade) Nom thk. (in.) Corr. allow. (in.) Inside diameter (ft & in.) length (overall)(ft & in.)
15. Seams
Longitudinal Heat treatment Radiographic treatment

Girth Heat treatment Radiographic treatment No. of courses

16. Heads: (a) (b)

Matl. Matl.
Spec. No., Grade Spec. No., Grade

Location
(Top, Bottom, Minimum Corrosion Knuckle Elliptical Conical Hemispherical Flat Side to Pressure
Ends) Thickness Allowance Radius Ratio Apex Angle Radius Diameter (convex or concave)
 (a)
(b)
17. If removable, bolts used (describe other
fastenings)
(Mat’l Spec. No., Grade, Size, No.)

18. Design psi at max °F Charpy ft -lb

Press. temp. Impact
at test temp. °F, Min. design metal ° F at psi. Pneu., hydro, or comb.
of temp.
test psi.
pressure

(7/00) This form (E00112) may be obtained from the Order Dept., ASME, 22 Law Drive, Box 2300, Fairfield, NJ 07007-2300.

Form A-1 (Back)

Items below to be completed for all vessels where applicable
19. Nozzles, inspection, and safety valve openings:
Purpose Diam. Nom Reinforcement How
(Inlet, Outlet, Drain, etc) No. or Size Type Material Thickness Material Attached Location

20. Supports:
Lugs Legs Others Attached
Skirt
(Yes or No) (No.) (No.) (Describe) (Where and How)
21. Service: Fatigue analysis and
required
yes or no Describe contents or service

22. Remarks: Manufacturer’s Partial Data Reports properly identified and signed by commissioned inspectors have been furnished for the following
items of the report:
name of part, item number, mfg’s name and identifying number

CERTIFICATION OF DESIGN
User's Design Specification on
file at:
Manufacturer's Design Report on file
at:
User's Design Specification Reg.
certified by: PE State No.
Manufacturer's Design report Reg.
certified by: PE State No.

CERTIFICATE OF SHOP COMPLIANCE

We certify that the statements made 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 ASME 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/or the State or Province
of 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 employed 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’l Board (incl. endorsements), State, Prov., and No

CERTIFICATE OF FIELD ASSEMBLY COMPLIANCE

We certify that the 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 in accordance with ASME Code, Section VIII, Division 2. The described vessel was inspected and subjected
to a hydrostatic test of psi. 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’l Board (incl endorsements) State, Prov. and No