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Project Name 5)'RWLhpbF{� liVALUE <br /> gGEINC <br /> Inspector`s Name StnP {TIwNfwi ' <br /> Unit Tested 10- <br /> Date 4 - 2 7 - zoo <br /> ANNUAL LCRS GAS TEST INSPECTION <br /> (A)PRE-TEST INSPECTION <br /> 1. Are all potential conduits seated properly? yes _ nom_ <br /> 2. Do any potential conduits require repair? yes nom_ <br /> 3. If any of the potential conduits required repair please list: , JA <br /> 4. Are any repairs needed to continue gas testing? yes no_/K <br /> 5. Total number of potential conduits that require repair:` -- <br /> 6. If repairs are required, complete a Maintenance Work Order(MWO). <br /> Comments: Av Ve. 1 ,C�`�' � �P c� lU� �Y CZ? �. 1 c'r✓�7 ► <br /> (B) GAS INJECTION PHASE <br /> Tracer Gas Used: v-r � -'/ Unit: <br /> Start time of tracer gas injection: // .. OAA Meter Start Reading: 073 <br /> Stop time of tracer gas injection: 2 : I/ • Meter Stop Reading: 039- t.1 <br /> Totat volume of tracer gas injected(cubic feet) : /t/' 8 <br /> Average flog rate of injected tracer gas(cubic feet per nnin.): 0 ,4'U Ccf <br /> Comments: t,!r ')'V -0 ,c 'L <br /> Ad , u 7 !` a <br /> Remedial Action Work Order Date Completed Signature <br /> e <br /> Signature of Inspector � ^` <br /> Paige 1 of 2 <br />