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AIR LEAK TEST REPORT

PROJECT NO : OCS- TEST DATE :


CLIENT REF. NO : REPORT NO :

INSTRUMENTATION AND GAUGE CALIBRATION RECORD


Date Of
Certificate Number QC Serial No. Manufacturer Range Remarks
Calibration

To Whom It May
Concern :
This Is To Certify That Leak Test Was Conducted on the
Equipment :

ITEM DESCRIPTION :

DRAWING NO. :

DESIGN PRESSURE :

TEST PRESSURE :

TEST TEMPERATURE :

HAS BEEN TESTED TO :

AND HELD FOR :

Without Any Signs Of Leakage And/Or Permanent


Deformation.

OCS QA/QC. THIRD PARTY

WITNESSED BY : WITNESSED BY :

SIGNATURE : SIGNATURE :

DATE : DATE :

CLIENT

WITNESSED BY : WITNESSED BY :
SIGNATURE : SIGNATURE :

DATE : DATE :