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 HYDROSTATIC/PNEUMATIC
TEST
RECORD
FILE NO.
DATE
FACILITY
PROCEDURE NO.
REV.
LEAD SHOP/WORK CENTER
JOB NO.
SYSTEM/COMPONENT TO BE TESTED:
1
DIAGRAM OF TEST AREA (DESCRIPTIVE OR DIAGRAMMATIC) INCLUDING GAGS AND BLANKS INSTALLED:
2
SOURCE OF PRESSURE:
3
CAPACITY (GPM/CPM):
4
TEST MEDIUM:
SOURCE OF TEST MEDIUM:
5
REQ'D TEST PRESSURE (PSIG):
ACTUAL TEST PRESSURE (PSIG):
CAPACITY (GPM)
DATE CHECKED
6
TEST RIG RELIEF VALVE SETTING (PSIG):
ACCURACY
PSIG)
DATE CHECKED
PRIMARY PRESSURE GAGE RANGE (PSIG):
7
ACCURACY
PSIG)
DATE CHECKED
8
BACKUP PRESSURE GAGE RANGE (PSIG):
9
REQUIRED TEST TIME MIN/HRS:
ACTUAL TEST DURATION MIN/HRS:
10
ACTUAL LEAKAGE RATE:
ALLOWABLE LEAKAGE RATE:
TEST RESULTS:
0 SAT
0 UNSAT
VERIFY GAGS AND BLANKS REMOVED:
RESTORE SYSTEM/COMPONENT TO NORMAL OR AS REQUIRED FOR SUBSEQUENT TEST.
INSPECTED BY
I DATE
APPROVED BY
DATE
REVIEWED BY
DATE
COPY TO:
E-4
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