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Closure Application Data Sheet

Request by: _______________________ Date: ____________________


Company: _______________________ City, State: ____________________
Phone: _______________________ Fax: ____________________
E-mail: _______________________ Reference: ____________________

Required Information Application No. 1 Application No. 2


Pipe Diameter
Wall Thickness
Design Pressure
Design Temperature
Corrosion Allowance
Horizontal or Vertical
Design Code
Material of Construction
Seal Material
Vessel Media
ASME "U" Stamp

Optional Information
Hinge Requirements
Cyclic Requirements
Mechanical or Chemical Restrictions
Paint / Finish
Inspection / Certifying Authority

Submit Information to: R&M Energy Systems


10906 FM2920, Tomball, Texas, 77375
Tel: (281) 351-2222, Fax: (281) 351-6557
E-mail: sales@rmenergy.com

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