FORM U-3A MANUFACTURER’S CERTIFICATE OF COMPLIANCE (ALTERNATIVE FORM) Page of
COVERING PRESSURE VESSELS TO BE STAMPED WITH THE UM DESIGNATOR [SEE U-1(j)]
As Required by the Provisions of the ASME Boiler and Pressure Vessel Code Rules, Section VIII, Division 1
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)
4. Type
(Horizontal, vertical, or sphere) (Tank, separator, etc.) (Capacity) (Manufacturer’s serial number)
(CRN) (Drawing number) (National Board number) (Year built)
5. ASME Code, Section VIII, Div. 1
[Edition and Addenda, if applicable (date)] (Code Case number)
6. Shell: (a) Number of course(s) (b) Overall length
Course(s) Material Thickness Long. Joint (Cat. A) Circum. Joint (Cat. A, B & C) Heat Treatment
No. Diameter Length Spec./Grade or Type Nom. Corr. Type Full, Spot, Eff. Type Full, Spot, Eff. Temp. Time
None None
Body Flanges on Shells
Bolting
Washer
No. Type ID OD Flange Thk Min Hub Thk Material How Attached Location Num & Size Bolting Material (OD, ID, thk) Washer Material
7. Heads: (a) (b)
(Material spec. number, grade or type) (H.T. — time and temp.) (Material spec. number, grade or type) (H.T. — time and temp.)
Thickness Radius Side to Pressure Category A
Location (Top, Elliptical Conical Hemis. Flat
Bottom, Ends) Ratio Apex Angle Radius Diameter Convex Concave Type Full, Spot, Eff.
Min. Corr. Crown Knuckle None
(a)
(b)
Body Flanges on Heads
Bolting
Washer
Location Type ID OD Flange Thk Min Hub Thk Material How Attached Num & Size Bolting Material (OD, ID, thk) Washer Material
(a)
(b)
8. Type of jacket Jacket closure
(Describe as ogee and weld, bar, etc.)
If bar, give dimensions. If bolted, describe or sketch.
9. MAWP at max. temp. Min. design metal temp. at .
(Internal) (External) (Internal) (External)
10. Impact test at test temperature of .
[Indicate yes or no and the component(s) impact tested]
11. Hydro., pneu., or comb. test pressure Proof test
(07/17)
FORM U-3A Page of
Manufactured by
Manufacturer’s Serial No. CRN National Board No.
12. Nozzles, inspection, and safety valve openings:
Purpose Material Nozzle Thickness Attachment Details
(Inlet, Outlet, Diameter Reinforcement Location
Drain, etc.) No. or Size Type Nozzle Flange Nom. Corr. Material Nozzle Flange (Insp. Open.)
13. Supports: Skirt Lugs Legs Others Attached
(Yes or no) (Number) (Number) (Describe) (Where and how)
14. Manufacturer’s Partial Data Reports properly identified and signed by Commissioned Inspectors have been furnished for the following items of
the report (list the name of part, item number, Manufacturer’s name, and identifying number):
15. Remarks
CERTIFICATE OF SHOP COMPLIANCE
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 1.
UM Certificate of Authorization Number Expires
Date Name Signed
(Manufacturer) (Representative)
Signed Certificate Number
(Certified Individual) (National Board CI number)
(07/17)