Your Name 

Company Name 

e-Mail Address 

Phone 

Fax 

Tag No. 

Code 

Purpose 

Line Size & Rating 

M.A.W.P. (Vessel Rating) 

Fluid 

Corrosive Agents 

Capacity 

MW/SG 

Operating Pressure 

Operating Temperature 

Required Relief Area 

Back or Constant Pressure 

Vacuum or Pulsating Service 

Discharged to 

Nominal Size 

Rating 

Assembly Type 

Drawing No. 

Base Material 

Holddown Material 

3rd Comp. Material 

Preassembly Screws 

Studs & Nuts 

1/4" Gauge Tap 

Nominal Size 

Type 

Non-Fragmenting Required 

Drawing No. 

Serial No. 

Specified Burst Pressure 

Manufacturing Range 

Rupture Tolerance 

Specified Coincident Temp. 

Top/Cover/Ring Material 

Disk/Seal Material 

Vacuum Support Material 

ASME Burst Certifications 

Manufacturing No.