*Customer Name
City, State

*Customer P.O.#

*Atlas Job#

*Customers Gage ID.#

Contents of Atlas's Long Form Certification 

*Gage Type

*Gage Tol. Class

*Gage Description

*Prescribed
Pitch Dia.

*Prescribed
Major Dia.

*Thd. Depth

*Laboratory Name
& Address

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*Actual Measurement
Front-Middle-Back

*Results

*Lab Tech. Initials

*Condition
Recieved & Returned

*Addition Comments
or Findings

*Environment Condition
& Proceedure Used

*Measurement
of Uncertainty

*Equipment Used
Test# & Due Dates

*Lab Tech. Signature
Printed Name/Title

*Date & Serial No.

*Go Member Actuals

*Nogo Member Actuals

*Atlas Form & Rev.#

*Calibration Due Date
Based on Frequency & Conditions of Use

*Major Dia. Actuals

*Depth Actuals

*Tolerance

*Additional Customer
Requirements