Company:
Facility Location:
Facility Registered Mark:
Date: Month Year
Responsible Manager: (Signature)
| Cylinder Identification | Protective Coating | |||||
|---|---|---|---|---|---|---|
| Serial Number | Identifying Symbol | Specification
and Service Pressure |
Manufacturer | Date of Mfg. (mm/yy) | Type | Condition |
| 110506 | 123 Inc. | DOT-4BA240 | M#### | 01/90 | Paint | Good |
| 296087 | TDG Cyl. | TC-4BWM16 | M#### | 03/02 | Galvanized | Fair |
| Cylinders Inspected for | ||||||||
|---|---|---|---|---|---|---|---|---|
| Serial Number | Corrosion and Pitting | Dents | Cuts, Digs and Gouges | Leaks | Fire Damage | Bulges | Neck Defects | Attachments |
| 110506 | checked✓ | checked✓ | checked✓ | checked✓ | checked✓ | checked✓ | checked✓ | checked✓ |
| 296087 | SC** | checked✓ | checked✓ | checked✓ | checked✓ | checked✓ | checked✓ | checked✓ |
| Disposition | |||
|---|---|---|---|
| Serial Number | Disposition | Date Inspected (dd/mm/yy) | Inspector Initals |
| 110506 | OK | 01-06-2012 | TC |
| 296087 | SC | 01-06-2012 | TC |
Disposition code: OK - Return to Service
SC - Scrap (Condemned)
Remarks: **Cylinder serial number 296087 - Condemned due to excessive corrosion