FORM U-1A MANUFACTURER'S DATA REPORT FOR PRESSURE VESSELS

(Alternative Form for Single Chamber, Completely Shop or Field Fabricated Vessels Only)
Part #

PO # As Required by the Provisions of the ASME Boiler and Pressure Vessel Code Rules, Section VIII, Division 1

1. Manufactured and certified by Manchester Tank IN, 905 X Street, Bedford, Indiana, 47421, USA
(Name and address of manufacturer)
2. Manufactured for STOCK
(Name and address of purchaser)
3. Location of Installation UNKNOWN
(Name and address)

Horizontal 243311 OH11924.5 305385-REV.A 243311 2010

(Horizontal or vertical, tank) (Manufacturer's serial number) (CRN) (Drawing No.) (National Board number) (Year built)
4. Type

5. The chemical and physical properties of all parts meet the requirements of material specifications of the ASME BOILER AND PRESSURE VESSEL
CODE. The design, construction, and workmanship conform to ASME Rules, Section VIII, Division 1 2007 to 09
N/A N/A (year) [Addenda (Date)]
(Code Case numbers) (Special Service per UG-120(d))

6. Shell: SA-414 GRADE G .163 in N/A 10" (OD) 0' 9.25"

(Material spec. number, grade) (Nominal thickness) (Corr. allow.) (Inner diameter) [Length (overall)]

7. Seams: TYPE 1 SPOT 85% N/A N/A TYPE 2 NONE 65% 1

[Long. (welded, dbl., sngl., lap, butt)] R.T.(Spot or Full) Eff.(%) (H.T. temp) Time (hr) [Girth. (welded, dbl., sngl., lap, butt)] [R.T. (spot or full)] Eff(%) No. of Courses

8. Heads: (a) Material SA-414 GRADE G (b) Material SA-414 GRADE G

(Spec. no., grade) (Spec. no., grade)
Location (Top, Bottom, Minimum Corrosion Crown Radius Knuckle Radius Elliptical Ratio Conical Apex Hemispherical Flat Side to Pressure (Convex or
Ends) Thickness Allowance Angle Radius Diameter Concave)
(a) ENDS .163 N/A N/A N/A 2:1 N/A N/A N/A Concave
(b) ENDS .163 N/A N/A N/A 2:1 N/A N/A N/A Concave
If removable, bolts used (describe other fastenings) N/A
(Material spec. number, grade, size, number)
9. MAWP 600 psi N/A at max. temp. 450 °F N/A
(Internal) (External) (Internal) (External)

Min. design metal temp. -20 °F at 600 psi . Hydro, pneu., or comb. test pressure HYDRO. at 780 psi
Proof test N/A

10. Nozzles, inspection and safety valve openings:

Purpose (Inlet, Outlet, Diameter or Nominal How

Number Type Material Reinforcement Material Location
Drain) Size Thickness Attached
INSP.OPEN. 1 .75" SCRD.CPLG. SA-105 3000# WELDED HEAD
INSP.OPEN. 1 1" SCRD.CPLG. SA-105 3000# WELDED HEAD
UNKNOWN 2 .75" SCRD.CPLG. SA-105 3000# WELDED
UNKNOWN 1 .5" SCRD.CPLG. SA-105 3000# WELDED

11. Supports: Skirt N/A Lugs N/A Legs 2 Other N/A Attached WELDED/BOTTOM
(Yes or no) (Number) (Number) (Describe) (Where and how)
12. Remarks: Manufacturer's Partial Data Reports properly identified and signed by Commissioned Inspectors, have been furnished for the following items of the report:
N/A
(Name of part, item number, Manufacturer's name and identifying stamp)
Constructed Under the Provisions of Para.UG-90(c)(2); Exempt from Impact
Testing by UG-20(f)

We certify that the statements made in this report are correct and that all details of design, material, construction, and workmanship of this vessel conform to the ASME BOILER
CERTIFICATE OF SHOP/FIELD COMPLIANCE

AND PRESSURE VESSEL CODE, Section VIII, Division 1. "U" Certificate of Authorization No. 6046 expires December 27, 2010

Date 02/16/2010 Co. name Manchester Tank IN Signed

(Manufacturer) (Representative)

CERTIFICATE OF SHOP/FIELD INSPECTION

Vessel constructed by Manchester Tank IN at 905 X Street, Bedford, Indiana, 47421, USA I, the
undersigned, holding a valid commission issued by The National Board of Boiler and Pressure Vessel Inspectors and/or the State or Province KY, IN
of employed by HSB CT, of Hartford, CT
and have inspected the component described in this Manufacturer's Data Report on
February 16, 2010 and state that, to the best of my knowledge and belief, the Manufacturer has constructed this pressure vessel in accordance with ASME BOILER AND
PRESSURE VESSEL CODE, Section VIII, Division 1. By signing this certificate neither the Inspector nor his/her employer makes any warranty, expressed or implied, concerning
the pressure vessel described in this Manufacturer's Data Report. Furthermore, neither the Inspector nor his/her employer shall be liable in any manner for any personal injury or
property damage or a loss of any kind arising from or connected with this inspection.

Date 02/16/2010 Signed Commissions 13406A, KY1010, IN1826

(Authorized Inspector) (National Board (incl. endorsements), State, Province and number)
1120344 exe: v6.3.133 Form and version: U1A-16