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Project Name F6Kwm4-) LA" br-JLL <br />SU - -IL <br />hisp,ector's Name-- 0 <br />Unit Tested- UAtl–IAl <br />Date <br />ANNUAL LCRS GAS TEST INSPECTION <br />(A) PRE-TEST INSPFCTION <br />1. Are all potential. conduits sealed properly? yes--)(— 110 <br />2. Do any potentialconduits require repair? yes_....___....._..._.. 110— <br />x <br />11'any ofthc potential miduits rcquired repair please list: NJA <br />4. Are any repairs needed to con ince gas testing? yes— no4-- <br />5. 'I"otal number of potential conduits that require repair:. _ 1W.GyJL <br />0. lfrepuirs are rcquiied, cuniplcvc. a Maintenance Work Or—der (MWO). <br />............ <br />INJE .XION PUPSE <br />Tracer Gn�, <br />Start ti Elle of tracer gas Injection: 33 AM <br />Stop time of tracer gas injection: <br />Al V4CUV-V,1 <br />Unit: tvlyiu — wew& <br />Meter Start Reading: A5, i' <br />Meter Stop Reading: 3458 - 8 <br />Total volume of'tracer gas injected (cubic feet) : ­­­ 1\5,{ 1 <br />Average flow rate of injected tracer gas(cubie feet per min.): <br />0 <br />Remedial Action <br />Work Order Date Completed <br />Signature <br />..... . .......... <br />Signature <br />,)f Inspector <br />Page I of 2 <br />