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NCPA Pressure Test Record Form <br /> NONTMfOx CC:ifOnm�a0µf11 nSfnC'r <br /> This form is required for documenting the results of every pressure test.Both the technician performing the test and the inspector witnessing it must sign. <br /> Copies(electronic or hardcopy)of the completed form are kept by the plant permanently. Keep this form and the Approved Pressure Test Procedure together <br /> as a single document. <br /> System Decription <br /> Pressure Test System ID(Description): <br /> NCPA LODI CT1 HYDROTEST OF UNDERGROUND DIESEL PIPE <br /> Test Parameters <br /> Type of test: ■ Hydrostatic ❑ Pneumatic <br /> Required test pressure:105 Test fluid: Diesel Actual test fluid temperature:68 F <br /> Test starting time:2/25/16 at 1150 AM Test ending time:2/25/16 at 12:36 PM <br /> Test duration(ending—starting time): 46 MINUTES Actual holding time: 10 minutes at 50 psig,100 psig,50 psig. A total of 30 minutes. <br /> Test Equipment—Pressure Gauge <br /> Type: Bourdon Tube Pressure Guage(316 SS Tube and Pressure range: 0-300 psig Calibration date: 3/19/2015,due 3/19/2016 <br /> Connection),Designed to ASME 640.100 <br /> Actual test pressure: 0-50 psig(1150-1205),50-105(12:05-12:22),105-50(1224-1236) <br /> Environmental Controls <br /> Exclusion zone for safety of people(actual safe distance): Front gate. <br /> Test area controls(barricades,signage,etc.): Caution Tape Actual disposal of test fluid: Placed back in the main diesel tank. <br /> Results <br /> Inspection: ■ PASS ❑ FAILED(explain) <br /> Pressure Test: Is PASS ❑ FAILED(explain) <br /> Remarks: <br /> 1150-1205: PRESSURIZED U/G DIESEL PIPE TO 50 PSIG TO CHECK FOR LEAKS. HELD AT 50 FOR 10 MINUTES. NO LEAKS. NO DECREASE IN PRESSURE. <br /> 1210-1222: INCREASED PRESSURE FROM 50 PSIG TO 105 PSIG. HELD AT 105 FOR 10 MINUTES. NO LEAKS. NO DECREASE IN PRESSURE. <br /> 1224-1236: DECREASED PRESSURE FROM 105 PSIG TO 50 PSIG. HELD AT 50 FOR 10 MINUTES. NO LEAKS. NO DECREASE IN PRESSURE. <br /> 1236: DECREASED PRESSURE FROM 50 TO ZERO. TEST COMPLETED. NO ISSUES. NO LEAKS. ALL SATISFACTORY. <br /> NOTE: SEE ATTACHED PERFORMANCE MECHANICAL,INC REPORT FOR ADDITIONAL INFORMATION. <br /> Signatures <br /> Technician Performing Test:(print): Signature: SEE PMI REPORT Date:2/25/2016 <br /> PERFORMANCE MECHANICAL,INC(PMI)-JACK <br /> WOOD <br /> Inspector/NCPA Management Witnessing Test: Signature: Date: 2/25/2016 <br /> (print): VINNIE VENETHONGKHAM <br /> MAY 232016 <br /> 8/12/15 by)/lame Vcnctbongkhem <br />