Gas Integrity Test Form PDF Details

Whenever a new gas pipeline is installed, the integrity of the pipe needs to be tested. There are several different methods that can be used for this purpose, and one of them is the Gas Integrity Test Form. This form is used to collect data about the pipeline and its surroundings. The information collected can help ensure that the pipeline is safe and operable. In order to complete a Gas Integrity Test Form, you will need to gather information about the pipe's material type, thickness, age, location, and other features. You will also need to take into account the soil conditions and environmental factors near the pipeline. By gathering all this information, you can create a detailed report that will help determine the safety of the pipeline.

QuestionAnswer
Form NameGas Integrity Test Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesaffidavit formate of bharat gas kolkata in name, gas testing form 2019, turn affidavit printable, coned gas itegrity test

Form Preview Example

Gas Integrity Test & Turn-On Affidavit

This certifies that the gas piping in the building indicated below has successfully passed a leakage test as prescribed by the local authority having jurisdiction.

(Building Address / City or Town / Zip Code)

 

Complete All Sections That Apply

Blue Card No.

Lockable valves and test ports installed / exist at the base of each riser. YES NO (Circle One)

Gas Turn-On requested for the following equipment (Specify below):

CONTACT INFORMATION FOR IMMEDIATE BUILDING ACCESS :_________________PHONE:______________

RISER LOCATION

 

GAS END USE

 

METER LOCATION

 

NO. OF

 

 

(e.g. Cooking, Heating,

 

 

 

 

 

 

APTS

 

 

 

Hot Water, Dryer, etc)

 

 

 

 

 

 

 

 

 

 

 

Location # 1

Location # 2

Location # 3

Location # 4

Location # 5

Location # 6

Contractor to Check Appropriate Corrective Condition:

I have repaired and tested,

Leak at gas equipment (specify unit or equipment)

 

 

Control Valve

 

Pilot Valve

 

 

Appliance Valve

Hood Draft

 

Appliance Regulator

 

Flue Connection

Other (Specify) and provide details for above items checked

This certifies that all gas piping is complete and continuous up to the appliance, including appliance control valves, or

end of use equipment in affected apartments or areas.

YES

NO (circle one)

It is also certified that in the affected area(s):

All areas containing gas utilization equipment (e.g. boiler room, laundry room) have been inspected and that

the equipment gas valves have been closed.

YES

NO (circle one)

All apartments containing gas appliances have been inspected and the appliance valves have been closed.

YES

NO (circle one)

All open-ended valves, stubs test connections, purge connections, or any other piping or fittings which could

be left open, have been closed gas tight with a threaded plug or cap. For premises which have meters in the apartments, the meter valves have been left open, so that the integrity test is complete up to the

appliance valves.YES NO (circle one)

In addition, I accept responsibility for the gas-in of any end of use equipment or appliances not gassed-in by Con Edison and identified above for turn-on. YES NO (circle one)

(Plumbing Contractor Company Name / Address / Telephone #)

 

 

 

 

 

(Plumber’s Signature / License # / SEAL/ Date)

Rev. /

 

 

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Other Specify and provide details, All apartments containing gas, and NO circle one of soundex wireline ges integrity tool

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Filling in section 3 in soundex wireline ges integrity tool

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