FORM K-2 MANUFACTURER’S PARTIAL DATA REPORT FOR HIGH PRESSURE VESSELSA Part of a Pressure Vessel Fabricated by One Manufacturer for Another Manufacturer

As Required by the Provisions of the ASME Boiler and Pressure Vessel Code, Section VIII, Division 3

1. Manufactured and certified by(name and address of manufacturer)

2. Manufactured for(name and address of purchaser)

(name and address)3. Location of installation

4. Type

5. User’s Design Specification on file at

Drawing no. Prepared by

6. Manufacturer’s Design Report on file at

Maximum metal temperatureMinimum design metal temperature

at

at

at

Performed in the

Name of Part Quantity Line No. CRN Year BuiltMfr’s. Identifying

NumberMfr’s. Drawing

NumberNational Board

Number

position

Impact tested at

8. ASME Boiler and Pressure Vessel Code, Section VIII, Division 3

9. Constructed to

10. Construction

11. Size and configuration

12. Supports and attachments

13. Design pressure at maximum coincident metal temperature

14. Test pressure

Prestress method

(horizontal/vertical) (Manufacturer’s serial no.) (CRN) (National Board No.)

[fluid(s) used in test](horizontal/vertical)

(I.D.) (length)

(prepared by)(drawing no.) (description of part inspected)

(year) (Code Case no.)

(cylindrical, spherical, other)

(pneum./hydro./combination)

(year built)

15. Identification of Part(s)

16. Remarks:

(07/17)

Certified by Licensing or Registration Authority Reg. no.

Certified by Licensing or Registration Authority Reg. no.

7. Material

Page of

CERTIFICATE OF SHOP COMPLIANCE

CERTIFICATE OF SHOP INSPECTION

Certificate of Authorization no. expires .

Date Co. name Signed(Manufacturer)

(Authorized Inspector) (National Board Authorized Inspector Commission number)

(Authorized Inspector) (National Board Authorized Inspector Commission number)

(representative)

vessel and state that parts referred to as data items , not included in the certificate of shop inspection,

I, the undersigned, holding a valid commission issued by the National Board of Boiler and Pressure Vessel Inspectors and employed by

Report on

of , have inspected the pressure vessel described in this Manufacturer’s Partial Data

Commissions

Certificate of Authorization no. expires .

, and state that, to the best of my knowledge and belief, the Manufacturer has constructed this

have compared the statements in this Manufacturer’s Partial Data Report with the described pressure

I, the undersigned, holding a valid commission issued by the National Board of Boiler and Pressure Vessel Inspectors and employed by

of

. By signing this certificate neither the Inspector nor his employer makes any warranty, expressed or implied, concerning the part

Date Signed

(Assembler that certified and constructed field assembly)Date Co. name

(representative)Signed

Date Signed Commissions

CERTIFICATE OF FIELD ASSEMBLY COMPLIANCE

CERTIFICATE OF FIELD ASSEMBLY INSPECTION

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 BOILER AND PRESSURE VESSEL CODE, Section VIII, Division 3.

We certify that the field assembly construction of all parts of this vessel conforms with the requirements of Section VIII, Division 3 of the ASME

BOILER AND PRESSURE VESSEL CODE.

part in accordance with ASME Code, Section VIII, Division 3. By signing this certificate neither the Inspector nor his employer makes any warranty,

expressed or implied, concerning the part described in this Manufacturer's Partial 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.

have been inspected by me and that to the best of my knowledge and belief, the Manufacturer has constructed and assembled this part in

accordance with the ASME Code, Section VIII, Division 3. The described vessel was inspected and subjected to a hydrostatic test of

described in this Manufacturer's Partial 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.

(07/17)

FORM K-2 Page of

Manufactured by

Manufacturer’s Serial No. CRN National Board No.

of: 1 Manufactured and certified by: 2 Manufactured for: name and address of purchaser: 3 Location of installation: 4 Type: Manufacturers serial no: CRN: National Board No: year built: Drawing no: Prepared by: 5 Users Design Specification on file at: Certified by: Licensing or Registration Authority: Reg no: 6 Manufacturers Design Report on file at: Certified by_2: Licensing or Registration Authority_2: Reg no_2: 7 Material: Impact tested at: 8 ASME Boiler and Pressure Vessel Code Section VIII Division 3: 9 Constructed to: Code Case no: prepared by: description of part inspected: 10 Construction: Prestress method: 11 Size and configuration: length: cylindrical spherical other: ID: 12 Supports and attachments: 13 Design pressure: at maximum coincident metal temperature: Maximum metal temperature: at: Minimum design metal temperature: at_2: 14 Test pressure: pneumhydrocombination: at_3: Performed in the: position: Name of PartRow1: QuantityRow1: Line NoRow1: Mfrs Identifying NumberRow1: Mfrs Drawing NumberRow1: CRNRow1: National Board NumberRow1: Year BuiltRow1: Name of PartRow2: QuantityRow2: Line NoRow2: Mfrs Identifying NumberRow2: Mfrs Drawing NumberRow2: CRNRow2: National Board NumberRow2: Year BuiltRow2: Name of PartRow3: QuantityRow3: Line NoRow3: Mfrs Identifying NumberRow3: Mfrs Drawing NumberRow3: CRNRow3: National Board NumberRow3: Year BuiltRow3: 1: of_2: Manufactured by: Manufacturers Serial No 1: CRN_2: National Board No_2: Certificate of Authorization no: expires: Date: Co name: have inspected the pressure vessel described in this Manufacturers Partial Data: of_3: Report on: Date_2: Commissions: Certificate of Authorization no_2: expires_2: Date_3: Co name_2: of_4: have compared the statements in this Manufacturers Partial Data Report with the described pressure: vessel and state that parts referred to as data items: accordance with the ASME Code Section VIII Division 3 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 part: Date_4: Commissions_2: Text1: Text2: