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FORM H-5 MANUFACTURER’S MASTER DATA REPORT FOR BOILERSCONSTRUCTED FROM CAST IRON
As Required by the Provisions of the ASME Code Rules, Section IV
1. Manufactured and certified by
2. Boiler type or model no.
Section Designation(list each individual section
in boiler assembly)
Section Designation Test No. 1 Test No. 2
Bursting Pressure, Metal Thickness Measured at Break orFracture, and eight of Section
Metal ThicknessAccording to Drawing
Pattern and/orPart No.
Test No. 3
Bar forTest No. 3
3. Boiler section data:
4. Boiler section bursting data:
5. Minimum specified tensile strength .
(a)
(a)
Section DesignationBar for
Test No. 1Bar for
Test No. 2
(a)
(b)
(c)
(d)
(e)
(b)
(c)
(d)
(e)
(b)(c)(d)(e)
(name and address of manufacturer) (foundry identification)
7. Specification no. and class of gray iron
8. Maximum Allowable working pressure of boiler*
*Determined by using formula in HC-402 and by selection of lowest values of bursting pressure from tests recorded in item 4 of this report.
6. Tensile strength of associated test bars:
(07/15)
W
Page of
FORM H-5 (Back)
10. Examination data:
12. ASME Certificate of Authorization no. to use the Certification Mark with H designator (cast iron).
NOTE: Signature of designed responsible engineering head of the manufacturer must be notarized.
Certificate expires
(a) Test engineer
9. Sketch of section with lowest bursting pressure:
Show location of
failure and indicate whether
principally in bending or tension.
11. Manufacturer’s certification:
Date
Certified to be true record
,
,
(07/15)
(name)
(b) Witness of test(s)
(c) Date(s) of destruction tests
(name)
(name and title)
Manufactured by
Boiler type or model no.
Page of