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 :