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Instructions: Please use 1 sheet per alloy. If using the same alloy but different hardness requirement, the use a separate sheet for each.

Present Condition of Parts

Item #1

Item #1 - Qty

Item #1 - Part Number

Item #1 - Description

Item #1 - Hardness

Item #1 - Job Number

Item #1 - Unit Weight

Item #1 - Total Weight Columns

Item #2

Item #2 - Qty

Item #2 - Part Number

Item #2 - Description

Item #2 - Hardness

Item #2 - Job Number

Item #2 - Unit Weight

Item #2 - Total Weight Columns

Item #3

Item #3 - Qty

Item #3 - Part Number

Item #3 - Description

Item #3 - Hardness

Item #3 - Job Number

Item #3 - Unit Weight

Item #3 - Total Weight Columns

Item #4

Item #4 - Qty

Item #4 - Part Number

Item #4 - Description

Item #4 - Hardness

Item #4 - Job Number

Item #4 - Unit Weight

Item #4 - Total Weight Columns

Select Alloy

If "Select Alloy" is "Other", please specify

Select Processes

Check Those That Apply

If the "Select Processes" requires extra information, please specify

Print Available?

If Yes, Please Attach Print

Additional Processing

Mask or Paint

Shot Blast
Rust Inhibitor

Quality Control Requirements

100% HARDNESS INSPECTION REQUIRED
CERTIFICATION OF HEAT TREATMENT
FURNACE CHARTS REQUIRED
HEAT-TREAT TO THE ATTACHED SPECIFICATION

CUSTOMER PICK UP
UPS
CALL

Quality commercial heat treating since 1946

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