# 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