HomeMy WebLinkAboutBoiler Inspection Report
FI~.sT IN$PECTION 0
INSPECTION PERIOD
o 1 YR. 3 YR.
(608) 266-1580
Department of Industry, Labor and Human Relations
BOilER-FIRED PRESSURE VESSEL
INSPECTION REPORT
Safety and Buildings Division, P.O. Box 7969, Madison, WI 53707
(Statutory Reference: Chap. 101, Wis. Stats. See Back For Code References)
CERT. EXP. DATE: OWNER NO. REGISTRATION NO. KIND OF INSPECTION:
MONTHNEAR
IS INSPECTION
NATURE OF BUSINESS
FOR DILHR USE ONLY
FILE NUMBER BATCH NUMBER
SUM CODE
DIST NO
o SPECIAL
EXTERNAL
. 0 OTHER NO.
HWH D OTHER
S
MANUFACTURER:
OBJECT LOCAT1O~NTY:
2 OWNER'S STREET ADDRESS:
OWNER'S CITY
ZIP CODE
SPECIFIC LOCATION OF OBJECT:
3 USER'S STREET ADDRESS
..,
TYPE:
USER'S CITY:
ZIP CODE
FUEL:
PREV. INSPECTl
E ISSUEQ .FOf3 THI~. 9~~c;Tt=;"~~_ . ". c.~ NEXT CERTlFlCA TE
Yes (If modifications, list below) NO (Explain fully below)
MENTS:
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9 ITEM
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10 COMPLIANCE DATE
istribution: White - DILHR; Green - Inspector; Yellow - Owner