THERMA

1601 Las Plumas Ave. TAG NO.___________________ San Jose, CA. 95133 Ph: (408) 347-3400

EQUIPMENT EXAMINATION REPORT

JOB #:
DATE:
EQUIP. TYPE: (Chiller, Tower, AHU, Boiler, VFD, etc.)
MODEL #:
FLUID A:

• INLET/OUTLET SIZE(S):
• FLOW RATE:
• CONN. TYPES: (Flange, Male/Female, Threaded (NPT), Socket Weld, Butt Weld, Hygienic Clamp)
  FLUID B:
• INLET/OUTLET SIZE(S):
• FLOW RATE:
• CONN. TYPES: (Flange, Male/Female, Threaded (NPT), Socket Weld, Butt Weld, Hygienic Clamp)

RATED CAPACITY:
MOTOR FRAME TYPE:
MOTOR HP/RPM:
MOTOR VOLTAGE:

RESULTS:

• ACCEPTED
• REJECTED
• HOLD
  COMMENTS: (GEAR BOX DATA, MOTOR FRAME & NEMA ENCL., ALL SERIAL #’s, TESTING REPORTS, ETC.)

THERMA EXAMINER

Rev. 0 FN 7.002.10