4. Type(Horizontal or vertical) (Gasketed, semiweld, brazed)

(b) (c)(Fixed material) (Movable material) (Other material)

7. Frame compression bolts and nuts

8. Impact test

9. Heat transfer plates

,

,

Qty. Type

Material

13. Supports:

15. Remarks:

14. Service: Fatigue analysis required

Lugs Legs Feet Others Attached

6. Endplates: (a)

No. Quantity Width Length Thickness Corr. Allow. Heat Treat Temp. Time

10. Chamber 1, MAWP

(Quantitiy of plates at shipment) (Minimum tightening dimension) (Maximum tightening dimension)

at max. temp MDMT at Hydro/pneu. test press.

11. Chamber 2, MAWP

12. Nozzles, connections, inspections, and safety valve openings:

at max. temp MDMT at Hydro/pneu. test press.

(Quantitiy) (Quantitiy) (Describe) (Where and how)

(Yes or No) (Describe contents or service)

Purpose(Inlet, Outlet,Drain, etc.)

Dia. orSize Nozzle Flange

FlangeRating

Nozzle Thickness How AttachedLocation

(Insp./Open.)Nom. C.A. Nozzle Flange

5. The chemical and physical properties of all parts meet the requirements of material specifications of the ASME BOILER AND PRESSUREVESSEL CODE. The design, construction, and workmanship conform to ASME Code, Section VIII, Division 2.

[Edition (Year)] Code case no.

Year built (National Board no.)

FORM A-1P MANUFACTURER’S DATA REPORTFOR PLATE HEAT EXCHANGERS

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)

(Manufacturer’s serial no.) (Drawing no.)(CRN)

(Quantity, diameter, material specification, and grade)

[Indicate YES and the component(s) impact tested, or NO]

(Plate model) (Material specification and grade) (Thickness) (Maximum plate count for frame assembly)

(07/17)

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FORM A-1P

CERTIFICATION OF DESIGNUser’s Design Specification on file atManufacturer’s Design Report on file atUser’s Design Specification certified by PE State Reg. No.Manufacturer’s Design Report certified by PE State Reg. No.

CERTIFICATE OF SHOP COMPLIANCEWe certify that the statements in this report are correct and that all details of design, material, construction, and workmanship of thisplate heat exchanger conform to the ASME Code for Pressure Vessels, Section VIII, Division 2.

“U2” Certificate of Authorization No. expires

Date Name SignedManufacturer Representative

CERTIFICATE OF SHOP INSPECTION

Plate heat exchanger made by at

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

have inspected the plate heat exchanger described in this Manufacturer’s Data Report on

Date Signed Commissions Authorized Inspector

,

(07/17)

CERTIFICATE OF FIELD ASSEMBLY COMPLIANCE

“U2” Certificate of Authorization No. expires

Date Name SignedAssembler 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 employed by of

Date Signed Commissions Authorized Inspector National Board Authorized Inspector Commission number

National Board Authorized Inspector Commission number

and state that, to the best of my knowledge and belief, the Manufacturer has constructed this plate heat exchanger in accordance with ASME Code, Section VIII, Division 2. By signing this certificate neither the Inspector nor his/her employer makes any warranty, expressed or implied, concerning the plate heat exchanger described in this Manufacturer’s’ Data Report. Furthermore, neither the Inspector nor his/her 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.

We certify that the field assembly construction of all parts of this plate heat exchanger conforms with the requirements of Section VIII, Division 2 of the ASME BOILER AND PRESSURE VESSEL CODE.

have compared the statements in this Manufacturer’s Data Report with the described plate heat exchanger and state that parts referred to asdata itemsnot 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 this pressure vessel in accordance with the ASME Code, Section VIII, Division 2.The described plate heat exchanger was inspected and subjected to a hydrostatic test of .By signing this certificate neither the Inspector nor his/her employer makes any warranty, expressed or implied, concerning the plate heat exchanger described in this Manufacturer’s Data Report. Furthermore, neither the Inspector nor his/her 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.

Manufactured by

Manufacturer’s Serial No. CRN National Board No.

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