# 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**