Form R1 Report Of Repair Page 2
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2NB-66, Rev. 13, (06/25/15)
(Form “R” Registration no.)
(P.O. no., job no., etc.)
CERTIFICATE OF COMPLIANCE
I,
, certify that to the best of my knowledge and belief the statements made in this report are
correct and that all material, construction, and workmanship on this Repair conforms to the National Board Inspection Code. National Board
“R” Certificate of Authorization No.
expires on
,
Date
Signed
,
(name of repair organization)
(authorized representative)
CERTIFICATE OF INSPECTION
I,
, holding a valid commission issued by the National Board of Boiler and Pressure Vessel
Inspectors and certificate of competency, where required, issued by the Jurisdiction of
and employed by
of
have inspected the work described in this report on
and state
,
that to the best of my knowledge and belief, this work complies with the applicable requirements of the National Board Inspection Code. By
signing this certificate, neither the undersigned nor my employer makes any warranty, expressed or implied, concerning the work described
in this report. Furthermore, neither the undersigned nor my employer shall be liable in any manner for any personal injury, property damage,
or loss of any kind arising from or connected with this inspection.
Date
Signed
(inspector)
(National Board and Jurisdiction no.)
This form may be obtained from The National Board of Boiler and Pressure Vessel Inspectors 1055 Crupper Avenue, Columbus, Ohio 43229-1183
Page 2 of 2
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