UFC 3-430-07
24 July 2003
including Change 1, Jan 2004 and Change 2, March 2005
APPENDIX E
REPORTS AND FORMS
Figure E-1 Inspection Report-Boiler
EXP DATE
A. ( ) INTERNAL -
WATERSIDE ( )
FIRESIDE ( )
DATE OF INSPECTION
B. ( ) PRESSURE TEST STRENGTH ( )
TIGHTNESS ( )
C. ( ) EXTERNAL/OPERATIONAL
NEXT WATERSIDE INSPECTION DUE:
NEXT STRENGTH TEST DUE:
1. FROM:
14. CERTIFICATE ISSUED
2.
TO:
15. BOILER INSPECTOR
3. MANUFACTURER:
NAVFAC No.
LICENSE No.
4. PROPERTY No.
5. MFG SERIALNo.
6. MFG MODEL No.
16. REASON FOR NOT ISSUING A
CERTIFICATE
7. BUILDING No.
8. YEAR BUILT
9. CAPACITY
11. PRESSURE
10. NATIONAL BOARD
DESIGN
OPER.
TEST
NUMBER
12. TYPE OF FUEL
13. TYPE OF BOILER
17. FEEDWATER TREATMENT
18. BOILER USE
19. COMBUSTION CONTROL (MFG NAME)
21. FLUE GAS TEMPERATURE
20. COMBUSTION
% EXCESS O2:
F
NOx(ppm) :
CO (ppm):
SAFETY DEVICES/SAFETY VALVES
22. MANUFACTURER
23. NUMBER
24. SIZE
25. PSI SETTING
26. CONDITION
FIRING EQUIPMENT
IN SERVICE
ALTERNATE
MANUFACTURER
MANUFACTURER
27.
TYPE
TYPE
28.
FUEL TYPE
FUEL TYPE
29.
30. INSPECTOR'S COMMENTS:
31. ATTACHMENTS
32. SIGNATURE
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