TE-NNN Gas Leak and Repair Report.docx
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- Solicitation number
- W911S6-16-R-0002
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TE-NNN Gas Leak and Repair Report
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Technical Exhibit Solicitation: W911S6-16-R-0002 4/26/2016
TE-NNN GAS LEAK AND REPAIR REPORT
RECEIPT OF REPORT
| DMO Number |
| Bldg # |
| Date |
| Time |
Location of Leak
Description of Leak
| Inside |
| Outside |
| Leak Detected By |
| Odor |
| Noise |
| CGI |
| Other |
| Leak Reported By |
| Public |
| Customer |
| Survey Crew |
| Other |
Report Received By
DISPATCHED
| Date |
| Time |
| Assigned To |
INVESTIGATION
| Date Arrived |
| Time Arrived |
| Investigated By |
| Leak Found |
| Yes |
| No |
| CGI Used |
| Yes |
| No |
| Leak Grade |
| 1 |
| 2 |
| 3 |
Findings:
| Reported to DPW |
| Name |
Tech Monitor 526-9243
| Date |
| Time |
Location of Leak
Cause of Leak
| Condition Made Safe |
| Date |
| Time |
REPAIR REPORT
| Leak At |
| Threads |
| Coupling |
| Weld |
| Valve |
| Other |
| Pipe |
| Size |
| Steel |
| Plastic |
| Cast Iron |
| Other |
| Depth |
| Coating |
| Enamel |
| Wrapped |
| Galvanized |
| Other |
| Coating Condition |
| Good |
| Fair |
| Poor |
| Soil Conditions |
| Sand |
| Clay |
| Loam |
| Other |
| Soil Moisture |
| Dry |
| Damp |
| Wet |
| Other |
Repairs Made
| Gas Off for More than 1 Hour |
| Yes / No |
Repair Coating Used
| Anodes Installed |
| Yes / No |
| Weight |
| Depth |
Completed By
Date
Supervisor Signature
Date
Copy of report sent to Government
TO BE SUBMITTED WITH IN 24 HOURS OF RESPONSE
| Time |
| Date |
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