LEAK TEST VALVE REPORT

DOC NO : REV . NO :

REPORT NO. : TEST PACKAGE NO.:

TAG/ITEM ENGINEERING DOCUMENT N. SUPPLIER DOCUMENT N. CODE/SPECIFICATION

IDENTIFICATION OF MONITORING AND MEASURING DEVICES PAGE: OF

DATE: MANUFACTURER:

TYPE VALVE
Gate Globe Ball x Check Butterfly

Size:4" Class (Rating):150

Trim material: Tag No. / symbol:

Body material: ID NO.:

Body Heat # Bonnet Heat #
FOR CAST STEEL VALVES ONLY

PRESSURE TEST
VALVE BODY HYDRO TEST

Test Duration :………………..………(min) Test Pressure ……………. Pass Fail

RETEST

Test Duration :………………..………(min) Test Pressure ……………. Pass Fail

UPSTREAM VALVE SEAT DOWNSTREAM VALVE SEAT

LOW PRESSURE TEST ……...………………..PSIG ………….……..LEAKAGE ………………..…… # DROPS , BUBBLES / MINUT

Pass Fail

HIGH PRESSURE TEST ……...………………..PSIG ………….……..LEAKAGE ………………..…… # DROPS , BUBBLES / MINUT

Pass Fail TEST DURATION …………………………..Minutes

Test Result: Accepted Rejected If rejected , see MER/NCR # ……………

NOTE: INSPECTION NOTIFICATION REFERENCE

REPORT NO.:

ISSUE DATE:

ABOVE MENTIONED LINE HAS BEEN ERECTED AS PER DWG.

SUBCONTRACTOR (QC) EPC CONTRACTOR OWNER

NAME : NAME : NAME :

SIGN : SIGN : SIGN :

DATE : DATE : DATE :