24 July 2003
including Change 1, Jan 2004 and Change 2, March 2005
Instructions for Completing Inspection Certificate for
Boiler - Unfired Pressure Vessel Form, NAVFAC (9-11014/32 (3/67)
Inspection Certificate for: Place "X" in appropriate box.
Activity: Name of activity, city, and state.
Location: Building number and when applicable room number/ name or location
outside building (example: east, west, north, south).
Serial No.: Manufacturer's number from nameplate.
National Board No.: When available.
Make: Manufacturer's name.
Pressure Allowed: Taken from nameplate unless reduced as a result of
This Certificate Expires: Month and year of expiration depending on inspection
Type of Inspection: Place "X" in appropriate box or boxes.
Name: Inspector will sign here.
Date: Date of signature.