Exhibit X - USS-7 Test Report.pdf

Prepared By:

Chris Espartero Sr Field Service Representative

North America Service Operations

Houston, TX

USS-7 Substation PM

April 20, 2021

Work Order: 08391081

2 | P a g e

EXECUTIVE SUMMARY

Schneider Electric Services perform Transformer and Switchboard PM in accordance with project specification and applicable industry standard on USS-7 Substation located at VA loading duct tunnel 2002 Holcombe Blvd Houston, Texas 77030. The site contact for this project was Joe

Ceasar of VA Medical Center Electrical Power Distribution Department (713)806-7506.

USS-7 480V Switchboard

USS-7 Switchboard Main Breaker operating mechanism failed to perform basic functions. USS-7

Main Breaker failed to close manually, and the tripping mechanism was defective. Loose parts were also found during breaker inspection. With the customers approval we transferred the main breaker AC pro trip unit, trip coil and current sensor to a similar spare breaker. The spare breaker was tested with satisfactory test results and was used to replace the existing USS-7 main circuit breaker that was sent to schneider electric breaker shop for major overhaul.

USS-7 Transformer

USS-7 Transformer temperature controller was not working and needed to be replaced. Fuse and relays were found to have been pulled out inside the temperature controller control cabinet which may have been done during previous troubleshooting. Transformer temperature is one the biggest contributing factor to the life of the transformer. Excessive heat on the transformer can reduce transformer efficiency and shorten the life of the transformer.

If there are any questions or concerns, please contact:

Chris Espartero

832-205-1547

Christopher.Espartero@se.com

USS-7_876101-E2_XD

DryTypeTransformerReport Source

4/18/2021 7:52:53 PMSession Test Date

Nameplate Company VA Medical Center Serial Number 876101-E2

Location 2002 Holcombe Blvd Houston, Texas 77030

Special ID USS-7 XFMR

Division Houston Circuit Designation USS-7 SUBSTATION

Manufacturer Square D Electric Class

Year Manufactured Type DryTypeTransformer

Mfr Location USA Winding Insulation Open-Wound

Coolant Select Coolant Weight 7710

Tank Type Select Tank Type BIL 110 kV

Dry Tank Type Ventilated VA Rating 1000 kV 12.47,0.48,* Insulation Material Nomex

Administration Test Date 4/18/2021 Test Time: 7:52 PM Weather Indoors

Air Temperature 23.9°C Apparatus Temperature

* Humidity 63 %

Tester C.Espartero Work Order Date Last Tested

Verified Test Set Type M4000 Date Retested

Verification Date Set Top Serial # Reason ROUTINE

Last Sheet # Set Bottom Serial # Travel Time

Purchase Order Ins. Book # Duration

Copies Sheet # Crew Size 1

1 - 6876101-E2

Session Notes

2 - 6876101-E2

Bushing Nameplate Designation Serial # Manufacturer Type C1 %PF C1 Cap C2 %PF C2 Cap Rated kV Amps

H1 H1 * * * * * *

H2 H2 * * * * * *

H3 H3 * * * * * *

LSR mA: 4.535/4.535, 1/1 Watts: 0.053/0.053, 1/1 Cap (pF): 1202.843/1202.843, 1/1

LSR mA: 0.924/0.924, 1/1 Watts: 0.036/0.036, 1/1 Cap (pF): 244.998/244.998, 1/1

LSR mA: 3.611/3.611, 1/1 Watts: 0.015/0.015, 1/1 Cap (pF): 957.922/957.922, 1/1

LSR mA: 3.611/3.611, 1/1 Watts: 0.017/0.017, 1/1 Cap (pF): 957.845/957.845, 1/1

LSR mA: 8.865/8.865, 1/1 Watts: 0.149/0.149, 1/1 Cap (pF): 2351.608/2351.608, 1/1

LSR mA: 5.254/5.254, 1/1 Watts: 0.130/0.130, 1/1 Cap (pF): 1393.749/1393.749, 1/1

LSR mA: 3.613/3.613, 1/1 Watts: 0.008/0.008, 1/1 Cap (pF): 958.291/958.291, 1/1

LSR mA: 3.611/3.611, 1/1 Watts: 0.018/0.018, 1/1 Cap (pF): 957.859/957.859, 1/1

Overall Tests - 2K # Insulation Test kV mA Watts % PF Meas. Cap (pF) IR Man.

1 CH+CHL 2.000 4.535 0.053 0.117 1202.843 Good

2 CH 2.000 0.924 0.036 0.387 244.998 Good

3 CHL(UST) 2.000 3.611 0.015 0.041 957.922 Good

4 CHL 0 3.611 0.017 0.047 957.845 Good

5 CL+CHL 1.000 8.865 0.149 0.168 2351.608 Good

6 CL 1.000 5.254 0.130 0.248 1393.749 Good

7 CHL(UST) 1.000 3.613 0.008 0.023 958.291 Good

8 CHL 0 3.611 0.018 0.051 957.859 Good

3 - 6876101-E2

LSR mA: 4.534/4.534, 1/1 Watts: 0.050/0.050, 1/1 Cap (pF): 1202.676/1202.676, 1/1

LSR mA: 0.924/0.924, 1/1 Watts: 0.036/0.036, 1/1 Cap (pF): 244.981/244.981, 1/1

LSR mA: 3.611/3.611, 1/1 Watts: 0.015/0.015, 1/1 Cap (pF): 957.737/957.737, 1/1

LSR mA: 3.610/3.610, 1/1 Watts: 0.014/0.014, 1/1 Cap (pF): 957.695/957.695, 1/1

LSR mA: 8.864/8.864, 1/1 Watts: 0.146/0.146, 1/1 Cap (pF): 2351.229/2351.229, 1/1

LSR mA: 5.254/5.254, 1/1 Watts: 0.124/0.124, 1/1 Cap (pF): 1393.626/1393.626, 1/1

LSR mA: 3.612/3.612, 1/1 Watts: 0.010/0.010, 1/1 Cap (pF): 958.213/958.213, 1/1

LSR mA: 3.610/3.610, 1/1 Watts: 0.022/0.022, 1/1 Cap (pF): 957.603/957.603, 1/1

Overall Tests - LG # Insulation Test kV mA Watts % PF Meas. Cap (pF) Tip UP FRANK™ IR Man.

1 CH+CHL 10.004 4.534 0.050 0.111 1202.676 *

2 CH 10.003 0.924 0.036 0.389 244.981 0.001 Good

3 CHL(UST) 10.003 3.611 0.015 0.042 957.737 0.001 Investigate

4 CHL 0 3.610 0.014 0.040 957.695 *

5 CL+CHL 0.499 8.864 0.146 0.164 2351.229 *

6 CL 0.500 5.254 0.124 0.235 1393.626 -0.012 Good

7 CHL(UST) 0.499 3.612 0.010 0.026 958.213 0.003

8 CHL 0 3.610 0.022 0.060 957.603 * Investigate

Winding Resistance

DETC LTC Phase Resistance Units Calculated Resistance

Correction Factor

Corrected Resistance

Percentage Deviation

3 A 301.7 milli Ohms * * * *

3 B 301.3 milli Ohms * * * *

3 C 301.1 milli Ohms * * * *

High Voltage

DETC LTC Phase Resistance Units Calculated Resistance

Correction Factor

Corrected Resistance

Percentage Deviation

3 A 465.7 micro Ohms * * * *

3 B 436.2 micro Ohms * * * *

3 C 420.9 micro Ohms * * * *

Low Voltage

Winding

Manufacturer Serial Number Configuration Winding Temperature

Temperature Rise

Factory Resistance

(Ohms)

Factory Temperature

Δ-Y * * * *

4 - 6876101-E2

Exciting Current Tests Manufacturer Type Steps Boost % Buck % Position Found Position Left Oil Volume

DETC 3 3 *

H3 H1 H1 H2 H2 H3

DETC LTC Test kV mA Watts X mA Watts X mA Watts X FRANK™ Manual

3 5 93.937 764.804 L 51.222 420.076 L 94.442 768.077 L Good

LSR mA: 93.937/93.937, 1/1 Watts: 764.804/764.804, 1/1 Cap (pF): */*, 1/1

LSR mA: 51.222/51.222, 1/1 Watts: 420.076/420.076, 1/1 Cap (pF): */*, 1/1

LSR mA: 94.442/94.442, 1/1 Watts: 768.077/768.077, 1/1 Cap (pF): */*, 1/1

Turns Ratio Tests Serial Number HV Winding LV Winding

Delta Wye

Connections - - -

Tap NP Volt Tap NP Volt Cal Ratio 1 Ratio 2 Ratio 3 Min. Lim Max. Lim FRANK™ Manual

3 12470 3 480 44.997 45.102 45.012 45.015 44.772 45.222 Good Good

5 - 6876101-E2

Exciting Current Plot

6 - 6876101-E2

ZONE INTLK

BREAKER TYPE

TRIP UNIT TYPE

BKR INT. RATING

MOUNTING

LOW VOLTAGE POWER CIRCUIT BREAKER

TEMPERATURE 68 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/01/21 50

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

SPARE BREAKER/USS-7 replacement

Javier Rojas

VA Hospital WO-08391081

Cleaned

C & L Cleaned

MATCHES DWG OR SPEC

GROUND CONNECTION

ONDS 416

50 KVA

MANUFACTURER

FUSE MFR.

BKR CATALOG NO. N/A

N/AFUSE CAT. NO.

1600 AMP Off

B.I.

THERMAL MEMORY

SENSOR TAPS

FRAME SIZE

MAIN / ARCING CONTACTS

BATTERY STATUS

PRIMARY DISCONNECTS

CELL AND RACKING DEV.

CLEAN/LUBE Description CLEAN/LUBECONDITION

Acceptable

Acceptable

Acceptable

N/A

Cleaned

ARC CHUTES

SECONDARY DISCONNECT

CONDITIONDescription CLEAN/LUBE

CleanedAcceptable

Description

Cleaned

C & L

N/AOPERATING MECHANISM C & L

PHASE BARRIERS Acceptable Cleaned

N/AAUXILIARY DEVICES

BLOWN FUSE INDICATOR N/A N/A N/AINTERLOCKS N/A N/A

OVERALL CONDITION Acceptable

CONDITION

N/A

Acceptable

Acceptable

Acceptable

N/A

BREAKER NAMEPLATE

INSPECTION

TARGETS

03001, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

D.O.

N/A

N/A

N/A

N/AMFR. DATE / CODE N/A

SN / SO NO.Westinghouse

AC PRO N/A

COUNTER READING AL N/A

FUSE AMPS N/A

COUNTER READING AF

RANGE

@1000VGIG-OHMS 20°C

753.0 753.0

73.0 73.0

TEST 1

TEST 3

1TEMPERATURE CORRECTION FACTOR TO 20°C, TCF

TEST 2

INSULATION RESISTANCE IN: CLOSED: POLE-POLE

797.0797.0

20°C ACTUAL

PH A

ACTUALACTUAL

A - B A-GND

CLOSED: POLE-GROUND OPEN: LINE-LOAD

20°C

PH B

PH C

B-GND

C-GND

B - C

C - A

826.0

690.0

433.0

406.0

104.0

874.0433.0

826.0

874.0

690.0 406.0

104.0

CONTACT RESISTANCE - MICRO-OHMS

POLE 1

FUSE 2FUSE 1 FUSE 3

N/A N/A N/A

POLE 3POLE 2

1.0

2.5

3.0

.20

2 OFF 3200 2 OFF

.2

.2

1.0

2.5

.4

1.0

2.5

3.0

.20

LONG TIME DELAY

SHORT TIME PICKUP

SHORT TIME DELAY

INSTANTANEOUS PICKUP

GROUND FAULT PICKUP

GROUND FAULT DELAY

LONG TIME PICKUP

AS FOUND

SETTING

AS TESTED

SETTING

AS LEFT

SETTING I2T ON

AS TESTED

SETTING

AS LEFT

SETTING I*2 T ON

AS FOUND

SETTING

CT / SENSOR TAP: 1600 AMPRATING PLUG:1600 AMP 1600 AMP

Overcurrent Settings

CT / SENSOR RATINGS:

.20 .4

320.2

AS FOUND

RANGE

MINIMUM MAXIMUM

3,337

0.22

0.41

3,337

0.22

5,081

0.41

3,392

0.21

5,140

0.45

3,392

0.21

5,140

0.45

3,307

0.21

5,174

0.44

3,307

0.21

5,174

0.44

6,000 0.08 0.18

960 0.38 0.5

POLE 3

AS FOUNDAS FOUND AS LEFT AS LEFT

3 10.43 1,043 1,043 10.38 10.38

1,638 1,624 1,624 1,642 1,642

NT NT NT

CURRENT

MULTIPLE

TEST

AMPERES

sec 12 sec

LONG TIME PICKUP

LONG TIME DELAY

MILLIVOLT DROP

4,800 7

1,638

10.43

SHORT TIME PICKUP

SHORT TIME DELAY 1.5

INSTANTANEOUS PICKUP

INSTANTANEOUS DELAY

GROUND FAULT PICKUP

GROUND FAULT DELAY 1.5

sec sec sec sec sec sec

AS LEFT

1,440 A A1,760

A A

AA

A A

4,320 5,220

3,5202,880

288 352

POLE 1

FUNCTION

POLE 2TEST RESULTS BY PRIMARY INJECTION

TECH NOTE(S): This spare breaker is replacing the existing USS-7 Main circuit breaker

COMMENTS: Installed new AC PRO retrofit kit. Performed preventive maintenance, repair, primary injected. All tests proved satisfactory.

DEFICIENCIES:

TWO-WINDING DRY-TYPE TRANSFORMER

TEMPERATURE 75 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

4/19/2021 63

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

DRY TYPE TRANSFORMER

Chris Espartero

N/A

N/A

VA Hospital WO-08391081

Acceptable

CONDITIONDescription CLEAN/LUBEDescription

N/A

Torqued

N/A N/A

N/A

N/A N/A

FANS

N/AAcceptable

Acceptable

N/A N/A N/A

N/A

N/AVENTILATION / FILTERS

N/A

PAINT Acceptable

INDOOR

CleanedAcceptable

N/A

MATCHES DWG OR SPEC

WEATHER

Cleaned

ENVIRONMENT

Acceptable

N/A

GAUGES

SUPPORT INSULATORS

N/ATorqued

Comment

Windings

Acceptable

N/A CABINET HEATERS

AUXILIARY DEVICES N/ATorqued

PRIMARY CONNECTIONS

TANK / FRAME GROUND

NEUTRAL GROUND

Description CONDITION

SEC. CONNECTIONS Acceptable

N/A

N/A

Acceptable

N/A Torqued

ARRESTERS

CORE GROUND

ALARMS / ANNUNCIATOR

CONTROLS

BUSHINGS

CLEAN/LUBE CLEAN/LUBECONDITION

TEMPERATURE GAUGES WERE RESETunavailable °CMAXIMUM WINDING TEMPERATURE (1)°CunavailableWINDING TEMPERATURE (1)

GAUGES

N/A

CLEAN

23210, REVISED 10/20/2020(888) 778-2733 www.schneider-electric.us

46 46

1,2031,2031,203

NAMEPLATE DATA

RATED CURRENT

RATED CURRENT

AMPERES

AMPERES/

11,846

3 4 5 kV PRI.

PRIMARY VOLTAGE

SECONDARY VOLTAGE 277 WYE

13,904

TAP POSITION/CONNECTION

12,782 12,158

1,000

CLASS

12,470

Phase 3876101-E2SERIAL NO.

kVA/

THERMAL RATINGS

DELTA

kV SEC.

IMPEDANCE

YEAR OF MANUF.N/A 1988

MANUFACTURER

SPECIFICATION NO. MANUF. LOCATION

TYPE AA/FA K FACTOR N/A °CTEMPERATURE RISE

U.S.A

B.I.L. RATINGWINDING MATERIAL Cu

LB

DELTA480

TAP VOLTAGES

WINDING POLARITY SUBTRACTIVE

WYE

1,000 / 1,000

12,470

TOTAL WEIGHT

Dry

SqD

RANGE

INSPECTION

INSULATION RESISTANCE TEST

TESTED

PRIMARY TO

SECONDARY AND GROUND

SECONDARY TO

PRIMARY AND GROUND

VOLTAGE

(VOLTS DC)

(MEGOHMS)

Windings TEST RESISTANCE

PRIMARY TO

SECONDARY

1.0 MINUTE0.5 MINUTE 0.5 MIN. 20C 1.0 MIN. 20C

DIELECTRIC

ABSORPTION

RATIO

TEMPERATURE CORRECTION FACTOR TO 20°C, TCF 1.195

5,000

1,000

5,000

765,000.0 914,175.0 1,300,000 1,553,500

1,033,675865,000.0810,210.0678,000.0

645,000.0 770,775.0 988,000.0 1,180,660

1.70

1.28

1.53

Calculated PASS/FAIL Calculated

PASS/FAIL

TO

% DEVIATIONMeasured

TRANSFORMER TURNS RATIO TESTS

Calculated PASS/FAIL

CALC.

RATIO

Secondary

VOLTAGE

ENTER Primary

VOLTAGE

X1 - X0 X0 - X2

H1 - H3 H2 - H1 H3 - H2

X3 - X0

TAP TO

TEST

3 45.102 45.012 45.0150.04 % PASS 0.04 % PASSPASS44.996 0.24 %12,470 277

TWO-WINDING DRY-TYPE TRANSFORMER

PAGEDRY TYPE TRANSFORMERDEVICE N/ADBID

23210, REVISED 10/20/2020(888) 778-2733 www.schneider-electric.us

H3-H1 X0-X3X0-X1

WINDING RESISTANCE

H2-H3

Meas. Corr.

TAP

POSITION

TEST

# (milliohms)H1-H2 (milliohms) (milliohms)

Corr.Meas. Corr.Meas.

(milliohms)

Corr. Corr.Meas. Corr.Meas.Meas.

X0-X2 (milliohms) (milliohms)

WINDING TESTED

(t = Equipment Temperature)

Values Corrected to: °C75

Aluminum windings

R(Corr) = R(Meas) * (234.5 + c) / (234.5 + t)Copper windings

R(Corr) = R(Meas) * (226 + c) / (226 + t)

(c = Corrected Temperature)

3 301.700 361.363 301.300 360.884 301.100 360.644 0.465 0.557 436.200 522.461 0.420 0.5031

Primary Secondary

TECH NOTE(S):

COMMENTS: Temperature control is not working fuse and relay have been pulled from control cabinet. All test results are satisfactory at this time.

TRIP UNIT TYPE

N/A

BKR INT. RATING

MOUNTING

LOW VOLTAGE POWER CIRCUIT BREAKER

TEMPERATURE 82 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/22/2021 96

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

BUS DUCT A

David Gordon

VA Hospital WO-08391081

800 AMP

N/A

N/A N/A

MATCHES DWG OR SPEC

GROUND CONNECTION

ONME

65K

MANUFACTURER

FUSE MFR.

BKR CATALOG NO. MEF836LSIG

N/AFUSE CAT. NO.

800 AMP Off

B.I.

THERMAL MEMORY

SENSOR TAPS

FRAME SIZE

MAIN / ARCING CONTACTS

BATTERY STATUS

PRIMARY DISCONNECTS

CELL AND RACKING DEV.

CLEAN/LUBE Description CLEAN/LUBECONDITION

N/A

N/A

Acceptable

N/A

N/A

ARC CHUTES

SECONDARY DISCONNECT

CONDITIONDescription CLEAN/LUBE

N/AAcceptable

Description

N/A

C & L

N/AOPERATING MECHANISM Cleaned

PHASE BARRIERS Acceptable N/A

N/AAUXILIARY DEVICES

BLOWN FUSE INDICATOR N/A N/A N/AINTERLOCKS

OVERALL CONDITION Acceptable

CONDITION

N/A

N/A

N/A

Acceptable

N/A

BREAKER NAMEPLATE

INSPECTION

TARGETS

03001, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

D.O.

N/A

N/A

N/A

N/AMFR. DATE / CODE N/A

SN / SO NO.Square D

Micrologic N/A

COUNTER READING AL N/A

FUSE AMPS N/A

COUNTER READING AF

RANGE

CONTACT RESISTANCE - MICRO-OHMS

POLE 1

FUSE 2FUSE 1 FUSE 3

N/A N/A N/A

POLE 3POLE 2

1 IN

8 7 8

.2

1 OUT

.9

4 IN

1 IN

LONG TIME DELAY

SHORT TIME PICKUP

SHORT TIME DELAY

INSTANTANEOUS PICKUP

GROUND FAULT PICKUP

GROUND FAULT DELAY

LONG TIME PICKUP

AS FOUND

SETTING

AS TESTED

SETTING

AS LEFT

SETTING I2T ON

AS TESTED

SETTING

AS LEFT

SETTING I*2 T ON

AS FOUND

SETTING

CT / SENSOR TAP: 800RATING PLUG:800 800

Overcurrent Settings

CT / SENSOR RATINGS:

1 OUT 4 IN

.4.2

AS FOUND

RANGE

MINIMUM MAXIMUM

NT

1.983

0.555

NT NT NT NT NT

4,200 1.6 2.6

800 0.5 0.6

POLE 3

AS FOUNDAS FOUND AS LEFT AS LEFT

NT NT NT

CURRENT

MULTIPLE

TEST

AMPERES

sec 15 sec

LONG TIME PICKUP

LONG TIME DELAY

MILLIVOLT DROP

3,200

8.936

SHORT TIME PICKUP

SHORT TIME DELAY 1.05

INSTANTANEOUS PICKUP

INSTANTANEOUS DELAY

GROUND FAULT PICKUP

GROUND FAULT DELAY 2.5

sec sec sec sec sec sec

AS LEFT

720 A A880

A A

AA

A A

3,600 4,400

6,1605,040

288 352

POLE 1

FUNCTION

POLE 2TEST RESULTS BY SECONDARY INJECTION

TECH NOTE(S): Did not perform insulation resistance test due to other electrical equipment, cables or bus duct connected to breaker.

All tested functions passed at this time.

COMMENTS:

TRIP UNIT TYPE

N/A

BKR INT. RATING

MOUNTING

LOW VOLTAGE POWER CIRCUIT BREAKER

TEMPERATURE 82 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/22/2021 96

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

BUS DUCT B

David Gordon

VA Hospital WO-08391081

800 AMP

N/A

N/A N/A

MATCHES DWG OR SPEC

GROUND CONNECTION

ONME

65K

MANUFACTURER

FUSE MFR.

BKR CATALOG NO. MEF836LSIG

N/AFUSE CAT. NO.

800 AMP Off

B.I.

THERMAL MEMORY

SENSOR TAPS

FRAME SIZE

MAIN / ARCING CONTACTS

BATTERY STATUS

PRIMARY DISCONNECTS

CELL AND RACKING DEV.

CLEAN/LUBE Description CLEAN/LUBECONDITION

N/A

N/A

Acceptable

N/A

N/A

ARC CHUTES

SECONDARY DISCONNECT

CONDITIONDescription CLEAN/LUBE

N/AAcceptable

Description

N/A

C & L

N/AOPERATING MECHANISM Cleaned

PHASE BARRIERS Acceptable N/A

N/AAUXILIARY DEVICES

BLOWN FUSE INDICATOR Acceptable N/A N/AINTERLOCKS

OVERALL CONDITION Acceptable

CONDITION

N/A

N/A

N/A

Acceptable

N/A

BREAKER NAMEPLATE

INSPECTION

TARGETS

03001, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

D.O.

N/A

N/A

N/A

N/AMFR. DATE / CODE N/A

SN / SO NO.Square D

Micrologic N/A

COUNTER READING AL N/A

FUSE AMPS N/A

COUNTER READING AF

RANGE

CONTACT RESISTANCE - MICRO-OHMS

POLE 1

FUSE 2FUSE 1 FUSE 3

N/A N/A N/A

POLE 3POLE 2

1 IN

7 7 7

.3

1 OUT

.9

4 IN

1 IN

LONG TIME DELAY

SHORT TIME PICKUP

SHORT TIME DELAY

INSTANTANEOUS PICKUP

GROUND FAULT PICKUP

GROUND FAULT DELAY

LONG TIME PICKUP

AS FOUND

SETTING

AS TESTED

SETTING

AS LEFT

SETTING I2T ON

AS TESTED

SETTING

AS LEFT

SETTING I*2 T ON

AS FOUND

SETTING

CT / SENSOR TAP: 600RATING PLUG:800 800

Overcurrent Settings

CT / SENSOR RATINGS:

1 OUT 4 IN

.4.3

AS FOUND

RANGE

MINIMUM MAXIMUM

NT

1.987

0.537

NT NT NT NT NT

3,150 1.6 2.6

800 0.5 0.6

POLE 3

AS FOUNDAS FOUND AS LEFT AS LEFT

NT NT NT

CURRENT

MULTIPLE

TEST

AMPERES

sec 15 sec

LONG TIME PICKUP

LONG TIME DELAY

MILLIVOLT DROP

2,400

8.937

SHORT TIME PICKUP

SHORT TIME DELAY 5.25

INSTANTANEOUS PICKUP

INSTANTANEOUS DELAY

GROUND FAULT PICKUP

GROUND FAULT DELAY 2.5

sec sec sec sec sec sec

AS LEFT

540 A A660

A A

AA

A A

2,700 3,300

4,6203,780

288 352

POLE 1

FUNCTION

POLE 2TEST RESULTS BY SECONDARY INJECTION

TECH NOTE(S): Did not perform insulation resistance test due to other electrical equipment, cables or bus duct connected to breaker.

All tested functions passed at this time.

SE SWITCHBOARD / SWITCHGEAR INSPECTION

TEMPERATURE 78 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

04/19/2021 57

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

480 VOLT SWITCHGEAR

Chris Espartero

VA Hospital WO-08391081

480/277

N/A

MANUFACTURER

1600 AMP

BUS CONNECTIONS

EXTERIOR CONDITION

CLEAN/LUBE CLEAN/LUBECONDITION

Acceptable

Acceptable

N/A

Acceptable

N/A

CONDITION

N/A

Description

Cleaned

N/A

INDICATORS / LAMPS

N/A

MATCHES DWG OR SPEC N/A

FUNCTIONAL CHECKS

BUS INSULATION N/A N/A Cleaned

KEY / MECH. INTERLOCKS

N/A

PLC's / HMI's N/A

CONDITION

N/A

N/A

N/A

N/A

Acceptable

NAMEPLATE

21001, REVISED 10/20/2020(888) 778-2733 www.schneider-electric.us

WITHSTAND RATING

TYPE / STYLECURRENT RATING QED

SN / SO NO. SYSTEM VOLTAGE

MODEL / CATALOG

N/A

45-08000-62S

INSPECTION

Acceptable

PT'S AND CT'S

New Cleaned AcceptablePOWER CABLES

N/A N/A N/A INTERCONNECT WIRING N/ARACKING / LIFTING MECHANISMS

Acceptable N/ADOORS / COVERS / GASKETS

CPT AND CPT XFER CKT. ANCHORAGE

GROUNDING

PHASING CHECK

CONTROL WIRING

SPACE HEATERS

Description

N/A

CleanedINTERIOR SECTIONS / CUBICLES

N/A

PHASE BARRIERS

SEQUENCE OF OPERATION

Description

N/A

N/A

N/A

N/A

N/A

Square D

RANGE

BARRIERS / SHUTTERS

@1000VGIG-OHMS 20°C

8.9 11.5

TEST 1

TEST 2

INSULATION RESISTANCE IN: PHASE-PHASE

29.723.0

20°CACTUALACTUAL

A - B A-GND

PHASE-GROUND

B-GND

C-GND

B - C

C - A

25.0

40.0

31.0

16.5

40.0

32.2

51.6 21.3TEST 3

N-GNDTEST 4

1.2896TEMPERATURE CORRECTION FACTOR TO 20°C, TCF

INSULATION RESISTANCE TEST

SECTION 1 SECTION 2 33 39 37 31

NBAFROM TO

BUS SECTION TESTED RESISTANCE IN MICRO-OHMS

C

RESISTANCE IN MICRO-OHMS

G

N

BUSWORK CONNECTION RESISTANCE

CBAFROM TO

BUS SECTION TESTED

G

TECH NOTE(S):

COMMENTS: All results are satisfactory at this time.

TRIP UNIT TYPE

CP22113

BKR INT. RATING

MOUNTING

LOW VOLTAGE POWER CIRCUIT BREAKER

TEMPERATURE 77 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

04/19/21 43

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

MAIN BREAKER

Javier Rojas

VA Hospital WO-08391081

Cleaned

C & L Cleaned

MATCHES DWG OR SPEC

GROUND CONNECTION

ONDS 416

50 KVA

MANUFACTURER

FUSE MFR.

BKR CATALOG NO. N/A

N/AFUSE CAT. NO.

1600 AMP Off

B.I.

THERMAL MEMORY

SENSOR TAPS

FRAME SIZE

MAIN / ARCING CONTACTS

BATTERY STATUS

PRIMARY DISCONNECTS

CELL AND RACKING DEV.

CLEAN/LUBE Description CLEAN/LUBECONDITION

Acceptable

Acceptable

Acceptable

N/A

Cleaned

ARC CHUTES

SECONDARY DISCONNECT

CONDITIONDescription CLEAN/LUBE

CleanedAcceptable

Description

Cleaned

C & L

N/AOPERATING MECHANISM C & L

PHASE BARRIERS Acceptable Cleaned

N/AAUXILIARY DEVICES

BLOWN FUSE INDICATOR N/A N/A N/AINTERLOCKS N/A N/A

OVERALL CONDITION Deficiency

CONDITION

N/A

Acceptable

Acceptable

Deficiency

N/A

BREAKER NAMEPLATE

INSPECTION

TARGETS

03001, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

D.O.

N/A

N/A

N/A

N/AMFR. DATE / CODE N/A

SN / SO NO.Westinghouse

AC PRO N/A

COUNTER READING AL N/A

FUSE AMPS N/A

COUNTER READING AF

RANGE

@1000VGIG-OHMS 20°C

381.0 476.3

305.0 381.3

TEST 1

TEST 3

1.25TEMPERATURE CORRECTION FACTOR TO 20°C, TCF

TEST 2

INSULATION RESISTANCE IN: CLOSED: POLE-POLE

448.8359.0

20°C ACTUAL

PH A

ACTUALACTUAL

A - B A-GND

CLOSED: POLE-GROUND OPEN: LINE-LOAD

20°C

PH B

PH C

B-GND

C-GND

B - C

C - A

306.0

357.0

342.0

294.0

354.0

351.0427.5

382.5

438.8

446.3 367.5

442.5

CONTACT RESISTANCE - MICRO-OHMS

POLE 1

FUSE 2FUSE 1 FUSE 3

N/A N/A N/A

POLE 3POLE 2

1.0

2.5

3.0

.20

2 OFF 3200 2 OFF

.2

.2

1.0

2.5

.4

1.0

2.5

3.0

.20

LONG TIME DELAY

SHORT TIME PICKUP

SHORT TIME DELAY

INSTANTANEOUS PICKUP

GROUND FAULT PICKUP

GROUND FAULT DELAY

LONG TIME PICKUP

AS FOUND

SETTING

AS TESTED

SETTING

AS LEFT

SETTING I2T ON

AS TESTED

SETTING

AS LEFT

SETTING I*2 T ON

AS FOUND

SETTING

CT / SENSOR TAP: 1600 AMPRATING PLUG:1600 AMP 1600 AMP

Overcurrent Settings

CT / SENSOR RATINGS:

.20 .4

320.2

AS FOUND

RANGE

MINIMUM MAXIMUM

3,330

0.18

0.40

3,330

0.18

4,920

0.40

3,210

0.18

4,952

0.45

3,210

0.18

4,952

0.45

3,200

0.18

4,780

0.42

3,200

0.18

4,780

0.42

6,000 0.08 0.18

960 0.38 0.5

POLE 3

AS FOUNDAS FOUND AS LEFT AS LEFT

3 9.15 8.66 8.66 8.83 8.83

1,750 1,698 1,698 1,721 1,721

NT NT NT

CURRENT

MULTIPLE

TEST

AMPERES

sec 12 sec

LONG TIME PICKUP

LONG TIME DELAY

MILLIVOLT DROP

4,800 7

1,750

9.15

SHORT TIME PICKUP

SHORT TIME DELAY 1.5

INSTANTANEOUS PICKUP

INSTANTANEOUS DELAY

GROUND FAULT PICKUP

GROUND FAULT DELAY 1.5

sec sec sec sec sec sec

AS LEFT

1,440 A A1,760

A A

AA

A A

4,320 5,220

3,5202,880

288 352

POLE 1

FUNCTION

POLE 2TEST RESULTS BY PRIMARY INJECTION

TECH NOTE(S): Original breaker is in the Schneider Electric breaker shop for major overhaul.

COMMENTS: To remedy the issue we removed the trip unit, the flux shifter and the current sensors along with harness and mounted it on a spare breaker compatible with the original. This breaker was tested and passed all tests. Its back in service without issues.

DEFICIENCIES: Breaker operating mechanism fail to performed basic functions. breaker failed to close manually the tripping mechanism was defective, loose parts also found.

TRIP UNIT TYPE

N/A

BKR INT. RATING

MOUNTING

LOW VOLTAGE POWER CIRCUIT BREAKER

TEMPERATURE 82 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/22/2021 96

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

B0I NHC

David Gordon

VA Hospital WO-08391081

N/A

N/A

N/A Cleaned

MATCHES DWG OR SPEC

GROUND CONNECTION

ONILL

200KA

MANUFACTURER

FUSE MFR.

BKR CATALOG NO. ILL34401021

N/AFUSE CAT. NO.

400 AMP Off

B.I.

THERMAL MEMORY

SENSOR TAPS

FRAME SIZE

MAIN / ARCING CONTACTS

BATTERY STATUS

PRIMARY DISCONNECTS

CELL AND RACKING DEV.

CLEAN/LUBE Description CLEAN/LUBECONDITION

Acceptable

N/A

Acceptable

N/A

N/A

ARC CHUTES

SECONDARY DISCONNECT

CONDITIONDescription CLEAN/LUBE

N/AAcceptable

Description

N/A

N/A

N/AOPERATING MECHANISM Cleaned

PHASE BARRIERS Acceptable N/A

N/AAUXILIARY DEVICES

BLOWN FUSE INDICATOR N/A N/A N/AINTERLOCKS

OVERALL CONDITION Acceptable

CONDITION

N/A

N/A

N/A

Acceptable

N/A

BREAKER NAMEPLATE

INSPECTION

TARGETS

03001, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

D.O.

N/A

N/A

N/A

N/AMFR. DATE / CODE N/A

SN / SO NO.Square D

GROUND SENSOR N/A

COUNTER READING AL N/A

FUSE AMPS N/A

COUNTER READING AF

RANGE

CONTACT RESISTANCE - MICRO-OHMS

POLE 1

FUSE 2FUSE 1 FUSE 3

N/A N/A N/A

POLE 3POLE 2

312332

TECH NOTE(S): Did not perform insulation resistance test due to other electrical equipment, cables or bus duct connected to breaker.

All tested functions passed at this time.

TRIP UNIT TYPE

N/A

BKR INT. RATING

MOUNTING

LOW VOLTAGE POWER CIRCUIT BREAKER

TEMPERATURE 82 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/22/2021 96

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

BUS DUCT C

David Gordon

VA Hospital WO-08391081

800 AMP

N/A

N/A N/A

MATCHES DWG OR SPEC

GROUND CONNECTION

ONME

65K

MANUFACTURER

FUSE MFR.

BKR CATALOG NO. MEF836LSIG

N/AFUSE CAT. NO.

800 AMP Off

B.I.

THERMAL MEMORY

SENSOR TAPS

FRAME SIZE

MAIN / ARCING CONTACTS

BATTERY STATUS

PRIMARY DISCONNECTS

CELL AND RACKING DEV.

CLEAN/LUBE Description CLEAN/LUBECONDITION

N/A

N/A

Acceptable

New

N/A

ARC CHUTES

SECONDARY DISCONNECT

CONDITIONDescription CLEAN/LUBE

N/AAcceptable

Description

N/A

C & L

N/AOPERATING MECHANISM Cleaned

PHASE BARRIERS Acceptable N/A

N/AAUXILIARY DEVICES

BLOWN FUSE INDICATOR N/A N/A N/AINTERLOCKS

OVERALL CONDITION Acceptable

CONDITION

N/A

N/A

N/A

Acceptable

N/A

BREAKER NAMEPLATE

INSPECTION

TARGETS

03001, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

D.O.

N/A

N/A

N/A

N/AMFR. DATE / CODE N/A

SN / SO NO.Square D

Micrologic N/A

COUNTER READING AL N/A

FUSE AMPS N/A

COUNTER READING AF

RANGE

CONTACT RESISTANCE - MICRO-OHMS

POLE 1

FUSE 2FUSE 1 FUSE 3

N/A N/A N/A

POLE 3POLE 2

1 IN

8 7 8

.2

1 OUT

.9

4 IN

1 IN

LONG TIME DELAY

SHORT TIME PICKUP

SHORT TIME DELAY

INSTANTANEOUS PICKUP

GROUND FAULT PICKUP

GROUND FAULT DELAY

LONG TIME PICKUP

AS FOUND

SETTING

AS TESTED

SETTING

AS LEFT

SETTING I2T ON

AS TESTED

SETTING

AS LEFT

SETTING I*2 T ON

AS FOUND

SETTING

CT / SENSOR TAP: 800RATING PLUG:800 800

Overcurrent Settings

CT / SENSOR RATINGS:

1 OUT 4 IN

.4.2

AS FOUND

RANGE

MINIMUM MAXIMUM

NT

5,608

2.020

0.546

NT NT NT NT NT

4,200 1.6 2.6

800 0.5 0.6

POLE 3

AS FOUNDAS FOUND AS LEFT AS LEFT

NT NT NT

CURRENT

MULTIPLE

TEST

AMPERES

sec 15 sec

LONG TIME PICKUP

LONG TIME DELAY

MILLIVOLT DROP

3,200

9.081

SHORT TIME PICKUP

SHORT TIME DELAY 1.05

INSTANTANEOUS PICKUP

INSTANTANEOUS DELAY

GROUND FAULT PICKUP

GROUND FAULT DELAY 2.5

sec sec sec sec sec sec

AS LEFT

720 A A880

A A

AA

A A

3,600 4,400

6,1605,040

288 352

POLE 1

FUNCTION

POLE 2TEST RESULTS BY SECONDARY INJECTION

TECH NOTE(S): Did not perform insulation resistance test due to other electrical equipment, cables or bus duct connected to breaker.

All tested functions passed at this time.

20°C

MEDIUM VOLTAGE AIR SWITCH

TEMPERATURE 82 °C

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/22/2021 96

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

MV AIR SWITCH -RA

David Gordon

VA Hospital WO-08391081

C & L

C & L Cleaned

MATCHES DWG OR SPEC

GROUND CONNECTION

COUNTER READING AF/AL

ARCING CONTACTS

HEATER CIRCUIT

MAIN CONTACTS

CUBICLE

CLEAN/LUBE Description CLEAN/LUBECONDITION

Acceptable

Acceptable

Acceptable

N/A

Cleaned

CONTROL CIRCUIT

FUSE HOLDERS

CONDITIONDescription CLEAN/LUBE

N/AN/A

Description

Cleaned

C & L

N/AOPERATING MECHANISM C & L

PHASE BARRIERS Acceptable Cleaned

N/AAUXILIARY DEVICES

ARC CHUTES N/A Cleaned CleanedINTERLOCKS Acceptable CleanedINS. LINKAGES / BRACES

OVERALL CONDITION Acceptable

CONDITION

Acceptable

Acceptable

Acceptable

Acceptable

Acceptable

SWITCH NAMEPLATE

INSPECTION

CONTROL WIRING

MEG-OHMS

06060, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

@500V

INSULATION RESISTANCE IN:

N/A

MANUFACTURER

RATED CURRENT INT. RATING

44035-233-51

N/A

15 kv

N/A

SN / SO NO.

RATED VOLTAGE

CATALOG NO.

MAX. VOLTAGE BIL RATING

TYPE / STYLE POWER ZONE

95 KA

N/A

ADDITIONAL INFO

PICKUP VOLTS PICKUP VOLTS

ADDITIONAL INFO

VOLT RANGE VOLT RANGE

PICKUP VOLTS

VOLT RANGE

ADDITIONAL INFO

DROP-OUT VOLTS

CHARGING MOTOR INFORMATION

N/A

CLOSE COIL INFORMATION

N/A N/A VoltsVolts

PICKUP VOLTS

Volts

TRIP COIL INFORMATION

Volts

ADDITIONAL INFO

VOLT RANGE

N/A

OPTIONAL INFORMATION

TEST RESULTS

MANUF. DATE

600 AMP

FUSE AMPS9F60BHH905FUSE MFG. GOUND FUSE CAT. NO. .5 amp

@1000VGIG-OHMS 20°C

0.0 0.0

TEST 1

TEST 3

17.48TEMPERATURE CORRECTION FACTOR TO 20°C, TCF

TEST 2

INSULATION RESISTANCE IN: CLOSED: POLE-POLE

20°C ACTUAL

PH A

ACTUALACTUAL

A - B A-GND

CLOSED: POLE-GROUND OPEN: LINE-LOAD

20°C

PH B

PH C

B-GND

C-GND

B - C

C - A

0.0

0.0 0.0

0.0

15 kv

SQUARED

65KV

RANGE

(µ-ohms) 65

POLE 2 POLE 3CONTACT RESISTANCE MEASUREMENTS

BYPASS CONTACT RESISTANCE at 10 A

POLE 1

86 70

10 AFUSE RESISTANCE at (m-ohms)

TECH NOTE(S): Did not test insulation resistance due to feeder cables connected to the switch.

20°C

MEDIUM VOLTAGE AIR SWITCH

TEMPERATURE 82 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/22/2021 96

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

MV AIR SWITCH -A1

David Gordon

VA Hospital WO-08391081

C & L

C & L Cleaned

MATCHES DWG OR SPEC

GROUND CONNECTION

COUNTER READING AF/AL

ARCING CONTACTS

HEATER CIRCUIT

MAIN CONTACTS

CUBICLE

CLEAN/LUBE Description CLEAN/LUBECONDITION

Acceptable

Acceptable

Acceptable

N/A

Cleaned

CONTROL CIRCUIT

FUSE HOLDERS

CONDITIONDescription CLEAN/LUBE

N/AN/A

Description

Cleaned

C & L

N/AOPERATING MECHANISM C & L

PHASE BARRIERS Acceptable Cleaned

N/AAUXILIARY DEVICES

ARC CHUTES Acceptable Cleaned CleanedINTERLOCKS Acceptable CleanedINS. LINKAGES / BRACES

OVERALL CONDITION Acceptable

CONDITION

Acceptable

Acceptable

Acceptable

Acceptable

Acceptable

SWITCH NAMEPLATE

INSPECTION

CONTROL WIRING

MEG-OHMS

06060, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

@500V

INSULATION RESISTANCE IN:

N/A

MANUFACTURER

RATED CURRENT INT. RATING

44035-234-57

N/A

15 kv

N/A

SN / SO NO.

RATED VOLTAGE

CATALOG NO.

MAX. VOLTAGE BIL RATING

TYPE / STYLE POWER ZONE

95 KA

N/A

ADDITIONAL INFO

PICKUP VOLTS PICKUP VOLTS

ADDITIONAL INFO

VOLT RANGE VOLT RANGE

PICKUP VOLTS

VOLT RANGE

ADDITIONAL INFO

DROP-OUT VOLTS

CHARGING MOTOR INFORMATION

N/A

CLOSE COIL INFORMATION

N/A N/A VoltsVolts

PICKUP VOLTS

Volts

TRIP COIL INFORMATION

Volts

ADDITIONAL INFO

VOLT RANGE

N/A

OPTIONAL INFORMATION

TEST RESULTS

MANUF. DATE

600 AMP

FUSE AMPS155OX80E-1DFUSE MFG. GOUND FUSE CAT. NO.

@1000VGIG-OHMS 20°C

0.0 0.0

TEST 1

TEST 3

1.4348TEMPERATURE CORRECTION FACTOR TO 20°C, TCF

TEST 2

INSULATION RESISTANCE IN: CLOSED: POLE-POLE

20°C ACTUAL

PH A

ACTUALACTUAL

A - B A-GND

CLOSED: POLE-GROUND OPEN: LINE-LOAD

20°C

PH B

PH C

B-GND

C-GND

B - C

C - A

0.0

0.0 0.0

0.0

15 kv

SQUARED

65 KA

RANGE

(µ-ohms) 48

POLE 2 POLE 3CONTACT RESISTANCE MEASUREMENTS

BYPASS CONTACT RESISTANCE at

POLE 1

40 37

10 A 13.5 13.814.9FUSE RESISTANCE at (m-ohms)

TECH NOTE(S): Did not test insulation resistance in the closed position due to feeder cables connected to the switch.

TRIP UNIT TYPE

N/A

BKR INT. RATING

MOUNTING

LOW VOLTAGE POWER CIRCUIT BREAKER

TEMPERATURE 82 °F

PAGE

END USER

CUSTOMER

2002 HOLCOMBE BLVD.

DEPARTMENT OF VETERAN AFFAIRS

SITE LOCATION

USS-7DESIGNATION

SUBSTATION BUILDING 100

05/22/2021 96

JOB #

DBID

END USER ASSET/ID

HUMIDITYDATE

TESTED BYELEMENT

SUB-ELEMENT

DEVICE

EQUIPMENT USED

ATS 37

David Gordon

3284,3230

VA Hospital WO-08391081

800 AMP

N/A

N/A N/A

MATCHES DWG OR SPEC

GROUND CONNECTION

ONME

65K

MANUFACTURER

FUSE MFR.

BKR CATALOG NO. MEF836LSIG

N/AFUSE CAT. NO.

800 AMP Off

B.I.

THERMAL MEMORY

SENSOR TAPS

FRAME SIZE

MAIN / ARCING CONTACTS

BATTERY STATUS

PRIMARY DISCONNECTS

CELL AND RACKING DEV.

CLEAN/LUBE Description CLEAN/LUBECONDITION

N/A

N/A

Acceptable

N/A

N/A

ARC CHUTES

SECONDARY DISCONNECT

CONDITIONDescription CLEAN/LUBE

N/AAcceptable

Description

N/A

C & L

N/AOPERATING MECHANISM Cleaned

PHASE BARRIERS Acceptable N/A

N/AAUXILIARY DEVICES

BLOWN FUSE INDICATOR N/A Torqued N/AINTERLOCKS

OVERALL CONDITION Acceptable

CONDITION

N/A

N/A

N/A

Acceptable

N/A

BREAKER NAMEPLATE

INSPECTION

TARGETS

03001, REVISED 10/19/2020(888) 778-2733 www.schneider-electric.us

D.O.

N/A

N/A

N/A

N/AMFR. DATE / CODE N/A

SN / SO NO.Square D

Micrologic N/A

COUNTER READING AL N/A

FUSE AMPS N/A

COUNTER READING AF

RANGE

CONTACT RESISTANCE - MICRO-OHMS

POLE 1

FUSE 2FUSE 1 FUSE 3

N/A N/A N/A

POLE 3POLE 2

1 IN

8 7 8

.2

1 OUT

.9

4 IN

1 IN

LONG TIME DELAY

SHORT TIME PICKUP

SHORT TIME DELAY

INSTANTANEOUS PICKUP

GROUND FAULT PICKUP

GROUND FAULT DELAY

LONG TIME PICKUP

AS FOUND

SETTING

AS TESTED

SETTING

AS LEFT

SETTING I2T ON

AS TESTED

SETTING

AS LEFT

SETTING I*2 T ON

AS FOUND

SETTING

CT / SENSOR TAP: 600RATING PLUG:800 800

Overcurrent Settings

CT / SENSOR RATINGS:

1 OUT 4 IN

.4.2

AS FOUND

RANGE

MINIMUM MAXIMUM

NT

4,188

1.984

0.555

NT NT NT NT NT

3,150 1.6 2.6

800 0.5 0.6

POLE 3

AS FOUNDAS FOUND AS LEFT AS LEFT

NT NT NT

CURRENT

MULTIPLE

TEST

AMPERES

sec 15 sec

LONG TIME PICKUP

LONG TIME DELAY

MILLIVOLT DROP

2,400

8.935

SHORT TIME PICKUP

SHORT TIME DELAY 1.05

INSTANTANEOUS PICKUP

INSTANTANEOUS DELAY

GROUND FAULT PICKUP

GROUND FAULT DELAY 2.5

sec sec sec sec sec sec

AS LEFT

540 A A660

A A

AA

A A

2,700 3,300

4,6203,780

288 352

POLE 1

FUNCTION

POLE 2TEST RESULTS BY SECONDARY INJECTION

TECH NOTE(S): Did not perform insulation resistance test due to other electrical equipment, cables or bus duct connected to breaker.

All tested functions passed at this time.