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 HOSE ASSEMBLY REPORT
FILE NO.
FACILITY
SERIAL NO.
ASS'Y NO.
SYSTEM
ASS'Y DATE
PLAN NO.
J. 0.
TYPE HOSE
FREE LENGTH OF HOSE ADEQUATE
SYSTEM
FITTING X-RAY REQ'D
YES
NO
SPRINGS AND SPACERS INSTALLED
PROPER CLEARANCE
ASSEMBLY PC. NO.
FITTINGS ETCHED
END SEALED
ASSEMBLED BY
DATE HOSE MF'D
FLUSHED & HYDRO TESTED
PSI
WITNESSED AND CERTIFIED BY SUPERVISOR
FACILITY INSPECTOR
DATE
NOTES:
TAGGED BY
FABRICATION TAG ATTACHED
DATE
DELIVERED TO
E-9
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