Attachment_3-AF_FORM_1222-AF_EQUIVALENT_(7-12-13)-Tests.docx

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OCONUS PACAF AND USAFE BOILER INSPECTIONS FY17
Solicitation number
FA805117R3009
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AF Form 1222

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Combo.docx DOCX document
OCONUS_Boiler_Inspections.pdf PDF
Attachment_1_-_SOW_Dated_1_April_2017.docx DOCX document
Base_Access_Info.docx DOCX document
CDRL_Attachment_4_-_INSTRUCTIONS_FOR_COMPLETING_AF_FORM_1222_(7-12-2013).docx DOCX document
Attachment_2_-_Required_Inspections_and_Schedule_Request_v1.0_06132017.docx DOCX document

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BOILER OR

PRESSURE VESSEL INSPECTION REPORT

1. TYPE OF INSPECTION (B – Boiler ☐; V – Pressure Vessel ☐)
2. DATE OF INSPECTION
INTERNAL AND EXTERNAL
☐BA
☐VA
INTERNAL EXTERNAL UNDER HYDROSTATIC TEST
☐BB
☐VB
3. INSPECTION/DELIVERY ORDER NO.
EXTERNAL UNDER OPERATION
☐BC
☐VC
EXTERNAL UNDER HYDROSTATIC TEST
☐BD
☐VD
4. CONTRACT NUMBER
EXPANSION/RECEIVER TANK
☐BE
☐VE

5. INSTALLATION

6. STATE

7. ZIP CODE

8. LOCATION (Bldg. No.)

9. PLANT
☐MANNED☐UNMANNED

10. OBJECT INSPECTED:

BOILER:
☐FIRE TUBE
☐CAST IRON
☐WATER TUBE
☐OTHER (SPECIFY)
UPV:
☐EXPANSION TANK
☐AIR RECEIVER
☐LP
☐OTHER (SPECIFY)
11. USE:
☐POWER
☐PROCESS
☐HTHW
☐HWH
☐STEAM HEATING
☐STORAGE
☐HEAT EXCHANGE

☐OTHER (SPECIFY)

12. MANUFACTURER
13. MFR. RATING (MBTU or
14(a). NATIONAL BOARD NO.
14(b). USAF NO.

KLBS/HR):

15. YEAR BUILT
16. YEAR INSTALLED
17. PRIMARY FUEL (BOILER)
18. SECONDARY FUEL
19. PRESSURE ALLOWED MAWP ________ PSIG at TEMP ____
20. ACTUAL OPERATING PRESSURE (PSIG)

Previous Inspection MAWP ________ PSIG at TEMP _____

21. SAFETY &/or RELIEF VALVE SETTING
22. PRESSURE &/or TEMP PRIOR INSPECTION
23. PRESSURE &/or TEMP THIS INSPECTION
24. EXPLAIN IF PRESSURE CHANGED
(PSIG &/or ° F) _________
(PSIG &/or ° F) _________
(PSIG &/or ° F) _________
25. METHOD OF FIRING (BOILERS):
26. PRESSURE GAGE CALIBRATED?☐YES☐NO
27. DATE/TYPE OF LAST INSPECTION
TYPE:DATE:
28. HYDROSTATIC TEST☐NEW☐RETEST☐REPAIR
DATE:PSIG:
29. LAST HYDROSTATIC TEST
DATE:PSIG:

30. REPAIRS/ALTERATIONS MADE SINCE LAST INSPECTION? ☐NONE ☐YES (SPECIFY)

31. INTERNAL INSPECTION (DESCRIBE INSPECTION FULLY):

32. EXTERNAL INSPECTION (DESCRIBE INSPECTION FULLY):
BOILER EFFICIENCY TEST RESULTS:

TEST

POSITION

O2 %
CO

(ppm)

EFF %
CO2 %
STACK

TEMP

(°F)

AIR

TEMP

(°F)

EXCESS

AIR %

HYDRO-CARBONS %

¾” DIA

½” DIA

¼” DIA

FUEL TYPE NG/FO: ______________ ENERGY CONTENT (BTU/ft3; BTU/gal) ________________

33. INSPECTION OF SAFETY DEVICES RELIEVING (lbs/hr)

MANUFACTURER
SET PRESSURE-PSIG
SIZE
CAPACITY
TESTED (Y/N?)
CONDITION & HOW TESTED

TOTAL RELIEVING CAPACITY (lbs/hr)

34. INSPECTION OF PRESSURE GAGES

GAGE
CONDITION
CORRECTIONS MADE
TESTED (Y/N?)
REASONS WHY NOT TESTED

35. OTHER APPLIANCES (e.g., WATER COLUMNS, GAGE GLASSES, GAGE COCKS, BLOWOFF PIPE & VALVE OR COCKS, FEED PIPE)

ITEM
CONDITION

36. CSD-1/NFPA 85 COMPLIANT? (FOR BC ONLY)

☐YES
☐NO (EXPLAIN IN BLOCK 37)
☐N/A

37. STATE CONDITION OF OBJECT

☐ SATISFACTORY
☐ UNSATISFACTORY (LIST DEFICIENCIES TO BE CORRECTED AND REPAIRS TO BE MADE.

USE A SUPPLEMENTAL SHEET, IF NECESSARY.)

38. CAN THE OBJECT CONTINUE IN OPERATION?
☐YES☐YES, WITH RESTRICTIONS (EXPLAIN ON SUPPLEMENTAL SHEET)☐NO (EXPLAIN ON SUPPLEMENTAL SHEET)

39. NAME AND TITLE OF INSPECTOR:

40. SIGNATURE OF INSPECTOR:

41. NATIONAL BOARD COMMISSION NUMBER:
42. DATE:

43. NAME AND TITLE OF AIR FORCE REPRESENTATIVE ACCOMPANYING INSPECTOR:

44. SIGNATURE:

45. DATE:

46. ACTIONS TAKEN BY AIR FORCE AT A LATER DATE TO RESOLVE DEFICIENCIES CITED ABOVE:

47. DATE OF ACTIONS TAKEN:

48. NAME AND TITLE OF AUTHORIZING OFFICIAL:

49. SIGNATURE OF AUTHORIZING OFFICIAL:

50. DATE:

AF FORM 1222-AF EQUIVALENT (7-12-13)

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