REQUEST FOR HYDRO VARIANCE

Hydro Variance request form

* Indicates Required Field

Enter today's date
(Format: mm/dd/yyyy)

Description of object

Is this a boiler or pressure vessel? Please check the appropiate box.

Boiler
Pressure Vessel

*State Equipment Number (This field is mandatory)

National Board Number

Equipment Serial Number

*Oklahoma Repair Number (This field in mandatory)

Name of the Authorized Inspector

Phone number for authorized inspector
(no dashes e.g. 5554443333)

Name of Requester

The phone number for the individual sumbitting this request
(no dashes e.g. 5554443333)

E-Mail address of individual submitting request

Location of Repair (Please check all boxes that apply)

*Reason for variance (please be specific). (This field is mandatory).

Any Non-Desctructive Equipment used in lieu of Hydro

*Please provide a description of Repair (This field is a mandatory)

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