PUMP EXAMINATION REPORT

JOB #:
PUMP TYPE:
SURFACE FINISH:
HEAT NUMBERS:
INLET/OUTLET SIZE:
CONNECTION: NPT
HEAD MATERIAL:
SEAL MATERIAL:
MOTOR HP/RPM:
DATE:

RESULTS: ACCEPTED

P. O. #:

HEAD DRAIN SIZE:
T.C. FLG
COUPLING TYPE:
RATED CAPACITY:
MTR’s PROVIDED (Y/N):
MOTOR TYPE:
MOTOR VOLTAGE:

REJECTED HOLD

COMMENTS: (GEAR BOX DATA, MOTOR FRAME & NEMA ENCL., ALL SERIAL #’s, SURFACE FINISH TESTING MAP, ETC.)

EXAMINER