758785 FORM U-1A MANUFACTURER'S DATA REPORT FOR PRESSURE VESSELS

(Alternative Form for Single Chamber, Completely Shop or Field Fabricated Vessels Only)
Shop Order Number

As Required by the Provisions of the ASME Boiler and Pressure Vessel Code Rules, Section VIII, Division 1 Page 1 of 2

1. Manufactured and certified by Arcosa Industries de Mexico S. de R.L. de C.V. - Huehuetoca Plant, Calzada de Marisoles Lote 1, Ex-Hacienda
de Jalpa, Huehuetoca, Estado de Mexico, C.P. 54683, Mexico
(Name and address of Manufacturer)
2. Manufactured for Arcosa Industries de México S de RL de CV, Monte Pelvoux No 111, 7º Piso, Lomas de Chapultepec, México, CDMX,
11000,
(Name and address of Purchaser)
3. Location of Installation NOT KNOWN
(Name and address)

Horizontal H2000152 thru H2000171 N/A 314894 Rev 01 H2000152-H2000171 2020

(Horizontal or vertical, tank) (Manufacturer's serial number) (CRN) (Drawing number) (National Board number) (Year built)
4. Type

5. ASME Code, Section VIII, Division 1 2017/ N/A N/A N/A

[Edition and Addenda, if applicable (date)] (Code Case numbers) [Special service per UG-120(d)]

6. Shell: SA-455 0.184" 0" 31.5" (OD) 54.50"

(Material spec. number, grade) (Nominal thickness) (Corr. allow.) (Inner diameter) [Length (overall)]
Body Flanges on Shells
Bolting
Flange How
No. Type ID OD Min Hub Thk Material Location Bolting Washer (OD, ID, Washer
Thk Attached Num & Size
Material thk) Material
N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
7. Seams: TYPE 1 FULL 100 N/A N/A TYPE 2 SPOT 80 1
[Long. (welded, dbl., sngl., lap, butt)] [R.T.(spot or full)] (Eff.,%) (H.T. temp) (Time, hr) [Girth. (welded, dbl., sngl., lap, butt)] [R.T. (spot or full)] (Eff., %) (No. of courses)
8. Heads: (a) Material (b) Material
SA-285C
(Spec. no., grade) (Spec. no., grade)
SA-285C

Location (Top, Bottom, Minimum Corrosion Crown Radius Knuckle Radius Elliptical Ratio Conical Apex Hemispherical Flat Side to Pressure (Convex or
Ends) Thickness Allowance Angle Radius Diameter Concave)
(a) LEFT 0.156" 0" N/A N/A N/A N/A 15.75" N/A Concave
(b) RIGHT 0.156" 0" N/A N/A N/A N/A 15.75" N/A Concave

Body Flanges on Heads

Min Hub
Type ID OD Flange Thk Material How Attached
Bolting

Thk
Location Num & Size Bolting Material
Washer (OD,
Washer Material
ID, thk)
(a) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
9. MAWP 250 psi - at max. temp. 125 °F -
(Internal) (External) (Internal) (External)
Min. design metal temp. -20 °F at 250 psi . Hydro, pneu., or comb. test pressure HYDRO. at 325 psi .

Proof test NA .

10. Nozzles, inspection and safety valve openings:

Purpose (Inlet, Outlet, Diameter or Material Nozzle Thickness Reinforcement Attachment Details Location (Insp.
No. Type
Drain, etc.) Size Nozzle Flange Nom. Corr. Material Nozzle Flange Open.)
MULTIVALVE(A) 1 NPS 3/4 CPLG #3000 SA-105 --- 0.1625" 0" N/A UW-16.2 (c) --- SHELL
FLOAT GAUGE(B) 1 NPS 1 CPLG #3000 SA-105 --- 0.2175" 0" N/A UW-16.2 (c) --- SHELL
FILL VALVE(C) 1 NPS 1 1/4 CPLG #3000 SA-105 --- 0.295" 0" N/A UW-16.2 (c) --- SHELL
RELIEF VALVE(D) 1 NPS 3/4 CPLG #3000 SA-105 --- 0.1625" 0" N/A UW-16.2 (c) --- SHELL
LIQUID OUT(E) 1 NPS 3/4 CPLG #3000 SA-105 --- 0.1625" 0" N/A UW-16.2 (c) --- SHELL

11. Supports: Skirt N/A Lugs 2 Legs 4 Other N/A Attached HEAD / SHELL WELDED
(Yes or no) (Number) (Number) (Describe) (Where and how)
12. Remarks: Manufacturer's Partial Data Reports properly identified and signed by Commissioned Inspectors, have been furnished for the following items of the report:
N/A
(Name of part, item number, Manufacturer's name and identifying stamp)
HORIZONTAL TANK PRESSURE VESSEL, 250 WG TO BE USED FOR NON-CORROSIVE SERVICE.MANUFACTURED UNDER
THE PROVISIONS OF UG-90 (C)(2) IMPACT TESTING EXEMPT PER UG-20(F). JOINT EFFICIENCY IS 0.80
BETWEEN HEADS/SHELL ACCORDING TO TABLE UW-12 (b). JOINTS CONNECTING HEMISPHERICAL HEADS TO SHELL
ACCORDING TO FIG UW-13.1 (i).
OVER PRESSURE PROTECTION PER UG-125 TO UG-140.S.O. 758785
 FORM U-1A Page 2 of 2

Manufactured by Arcosa Industries de Mexico S. de R.L. de C.V. - Huehuetoca Plant, Calzada de Marisoles Lote 1, Ex-Hacienda de Jalpa,
Huehuetoca, Estado de Mexico, C.P. 54683, Mexico
Manufacturer's Serial No. H2000152 thru H2000171 CRN N/A National Board No. H2000152-H2000171

CERTIFICATE OF SHOP/FIELD COMPLIANCE

We certify that the statements made in this report are correct and that all details of design, material, construction, and workmanship of this vessel
conform to the ASME BOILER AND PRESSURE VESSEL CODE, Section VIII, Division 1. "U" Certificate of Authorization Number 21957
expires September 13, 2022 .
Date 01/17/2020 Co. name Arcosa Industries de Mexico S. de R.L. de C.V. - Huehuetoca Plant Signed
(Manufacturer) (Representative)

Arcosa Industries de Mexico S. de R.L. de C.V. - Huehuetoca Calzada de Marisoles Lote 1, Ex-Hacienda de Jalpa, Huehuetoca, Estado
CERTIFICATE OF SHOP/FIELD INSPECTION

Vessel constructed by Plant at de Mexico, C.P. 54683, Mexico

I, the undersigned, holding a valid commission issued by The National Board of Boiler and Pressure Vessel Inspectors and employed by
OneCIS Insurance Company, of Lynn, MA
have inspected the component described in this Manufacturer's Data Report on January 17, 2020 ,
and state that, to the best of my knowledge and belief, the Manufacturer has constructed this pressure vessel in accordance with ASME BOILER
AND PRESSURE VESSEL CODE, Section VIII, Division 1. By signing this certificate neither the Inspector nor his/her employer makes any
warranty, expressed or implied, concerning the pressure vessel described in this Manufacturer's Data Report. Furthermore, neither the Inspector
nor his/her employer shall be liable in any manner for any personal injury or property damage or a loss of any kind arising from or connected with
this inspection.

Date 01/17/2020 Signed Commissions 14710

(Authorized Inspector) (National Board Authorized Inspector Commission number)

3576678 exe: v6.3.67 Form and version: U1A-19