Lord
Corporation
CERTIFIED TEST REPORT - HARDNESS TESTING REQUIRED
(FORM 460 CLAUSE 102)
(If an equivalent form is used it must contain all required information.)
It is hereby certified that report contains actual hardness test results. Records supporting this
certification will be available for review and maintained on file for a period of not less than ten (10)
years (or as specified by quality clause 349 thru 355) from date of shipment.
Signature and Title of an
Authorized Representative
of Agency Performing Test:
_____________________________________________
Signature
_____________________________________________
Title
Name of the Facility:
and Address That
Performed the Test:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Lord Purchase Order Number:
_______________
Lord Part Number:
_____________________________________________
Lord Drawing / Revision:
_________________________ / _________________
Quantity Shipped:
_____________________________________________
Date Shipped:
_____________________________________________
test performed:
_____________________________________________
Test Lowest Value:
_____________________________________________
Test Highest Value:
_____________________________________________
Sample Size:
_____________________________________________
P.O. Change Order #:
_______
List all Serial Numbers Below. STATE “N/A” IF NOT APPLICABLE:
______________________________________________________________________________________
______________________________________________________________________________________
Form 460-102 8/11/2003