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FORM RP-1 FABRICATOR’S DATA REPORT FOR FIBER-REINFORCED PLASTIC PRESSURE VESSELS (CLASS I) (Revision D — 2017) As Required by the Provisions of the ASME Boiler and Pressure Vessel Code 1. Fabricated and certified by (name and address of Fabricator) 2. Fabricated for (name and address of Purchaser) 3. Location of installation (name and address) 4. Type Vessel No. Year Built (dwg. no.) [Edition and Addenda (if applicable) Date] (National Bd. no.) (Code Case No.) (bag molded, centrif. cast, filament wound) (molded, centrifugally cast, filament wound) (integral, adhesive bonding, bolted, quick opening, etc.) (CRN) (horiz. or vert. vessel) 5. Vessel fabricated in accordance with Design Specification no. 6. ASME Section X 7. Tests on prototype vessel conducted and certified by 8. Fabricated for 9. SHELL: Type Nominal thickness Diameter Length Barcol hardness (a) (1) (2) (1) (Material, Spec. no., T. S., size, number) (2) (1) (2) (b) If bolted, bolts used (1) (Describe or attach sketch) (2) (c) If quick opening or other Location (Top, Bottom, Ends) Nominal Thickness Barcol Hardness Nominal Weight Shape or Contour (Describe, giving radii, angle, ratios, where appropriate) (d) If filament wound, describe pole pieces or head fittings Location Attachment 10. HEADS: Type 11. SAFETY OR SAFETY RELIEF VALVE OUTLETS: Number Size and Procedure Specification no. Date Date Maximum allowable working pressure psi (kPa) at maximum allowable temperature Minimum allowable temperature [when less than -20°F (-29°C)] Hydrostatic, Pneumatic, or Test pressure Total weight of completed vessel . Combination (Manufacturer’s serial) (07/17)

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Page 1: FORM RP-1 FABRICATOR’S DATA REPORT FOR FIBER …

FORM RP-1 FABRICATOR’S DATA REPORT FOR FIBER-REINFORCED

PLASTIC PRESSURE VESSELS (CLASS I) (Revision D — 2017)

As Required by the Provisions of the ASME Boiler and Pressure Vessel Code

1. Fabricated and certified by(name and address of Fabricator)

2. Fabricated for(name and address of Purchaser)

3. Location of installation(name and address)

4. Type Vessel No. Year Built (dwg. no.)

[Edition and Addenda (if applicable) Date]

(National Bd. no.)

(Code Case No.)

(bag molded, centrif. cast, filament wound)

(molded, centrifugally cast, filament wound)

(integral, adhesive bonding, bolted, quick opening, etc.)

(CRN) (horiz. or vert. vessel)

5. Vessel fabricated in accordance with Design Specification no.

6. ASME Section X

7. Tests on prototype vessel conducted and certified by

8. Fabricated for

9. SHELL: Type Nominal thickness

Diameter Length Barcol hardness

(a)

(1)

(2)

(1)

(Material, Spec. no., T. S., size, number)

(2)

(1)

(2)

(b) If bolted, bolts used

(1)

(Describe or attach sketch)

(2)

(c) If quick opening or other

Location

(Top, Bottom, Ends)

Nominal

Thickness

Barcol

Hardness

Nominal

Weight

Shape or Contour

(Describe, giving radii, angle, ratios,

where appropriate)

(d) If filament wound, describe pole pieces or head fittings

Location

Attachment

10. HEADS: Type

11. SAFETY OR SAFETY RELIEF VALVE OUTLETS: Number Size

and Procedure Specification no.

Date

Date

Maximum allowable working pressure psi (kPa) at maximum allowable temperature

Minimum allowable temperature [when less than �20�F (�29�C)]

Hydrostatic,

Pneumatic, or Test pressure Total weight of completed vessel .

Combination

(Manufacturer’s serial)

(07/17)

Page 2: FORM RP-1 FABRICATOR’S DATA REPORT FOR FIBER …

FORM RP-1 (Back) (Revision D — 2017)

CERTIFICATE OF COMPLIANCE

CERTIFICATE OF SHOP INSPECTION

12. NOZZLES:

13. INSPECTION OPENINGS:

14. SUPPORTS: Skirt Lugs Legs Other

15. REMARKS

(Brief description of purpose of the vessel, such as air tank, water tank, LPG storage, etc. If description of the purpose of the vessel does not clearly indicate the contents of the vessel, state what the contents are to be. Describe any unusual features of design or construction not covered by items 3 to 14 inclusive.)

Date

Commission (Authorized Inspector’s signature) (National Board Authorized Inspector Number)

(Fabricator) (authorized representative)

(date)

Date

We certify the statements in this Data Report to be correct.

Signed by

of

have inspected the pressure vessel described in this Fabricator’s Data Report on and state that, to the best of

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

at

Our Certificate of Authorization No. to use the Certification Mark with RP Designator expires

(describe) (number)

(where and how)

(where and how)

(number) (yes or no)

Attached

Attached

Manholes: No.

Purpose (Inlet,Outlet, Drain)

Diameter or Size

Reinforcement Material Number Type Material Thickness How Attached

Size Location

Handholes: No. Size Location

Threaded: No. Size Location

my knowledge and belief, the Fabricator has constructed this pressure vessel in accordance with the applicable Sections of the ASME BOILER

AND PRESSURE VESSEL CODE.

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

described in this Fabricator's Data Report. Furthermore, neither the Inspector nor his employer shall be liable in any manner for any personal

injury or property damage or loss of any kind arising from or connected with this inspection.

(07/17)

(date)