MEC-TRIC CONTROL COMPANY 411 0 MONROE ROAD P.O. BOX 221918 CHARLOTTE, N.C. 28222 (704) 376-8555 FAX (704) 375-1728 Control Number V/UV As Found Test Report Dummy 2 Page 1 of 2 Assembly Order Sold To Plant 1 Plant 1 Lane City Raleigh State North Carolina Zip 12345 Cust. Order No.: 123456789 Ship To Plant 2 Plant 2 Lane City Raleigh 2 State North Carolina 2 Zip 12345-2 Date Shipped: December 27, 2023 Shipped Via: UPS Order Date 1703610240 Customer ID 01-111111 Date Req. December 28, 2023 Written By Ben Simons Contact: Plant 1 Maintenance Manager Email: plant1@yahoo.com Phone Number: 919-919-9191 Description Model Number: 27DA13-M40 Assembled By: LD Spring No.: C3030 Inlet Size: 1/2" Inlet Connection: MNPT Set Pressure: 100 PSIG Service: Liquid Orifice: D Orifice Capacity: 31 US GPM Spring Range: 90-105 PSIG Outlet Size: 1" Outlet Connection: MNPT Over Pressure 10% BP: 22in WC Serial Number: 123456 Tagging Instructions: PSV-1 Temp. 72 F Special Instructions: test qwe qwe 123 qwe qweqw qweqweqweqweqwe test qwe qwe 123 qwe qweqw qweqweqweqweqwe MATERIAL REQUISITION Description MCC-C Drawn From Stock Date Ordered qwlemq;w qwle;mq; 1 February 2, 2024 alsdm akasdm 2 February 22, 2024 aosjdj askdoon 3 aksdkalsd qwepqwoe 4 February 15, 2024 SHOP Nameplate Code Stamping Code Stamping: UV Reason - Not Code Stamped : N/A Date: December 28, 2023 Tester: LD C.I.: LD Date Completed: December 29, 2023 Seals: Larry Dennis Tag: Larry Dennis Test Media: Water Cert. Lift In Inches : 11 Set: 100 PSIG B.D.: 7 In WC B.P.: 22 in WC Over Pressure: 10% Leak Tight To: 90 PSIG Dyn Or Static Dynamic Gauge No: DPG-22 Simmer 223 CDTP@: 100 PSIG Pop 101 PSIG B.P. TEST @: No in WC Reseat 95 PSIG Number Of Notches: N/A B.D. 7 In WC Leak: No

MEC-TRIC CONTROL COMPANY 411 0 MONROE ROAD P.O. BOX 221918 CHARLOTTE, N.C. 28222 (704) 376-8555 FAX (704) 375-1728 Control Number V/UV M3-8425-1 (Copy-1) Page 2 of 2 IMAGES BEFORE AFTER TAG IMAGE