Assessment Submitted By

Owner/Operator

Plant Contact

Job Site Address

City

State

Zip

Phone

Fax

Email

Contractor/Installer

Contractor Field Contact (Name)

Field Office Address

State

Zip

Phone

Fax

Email

Please check all that apply.

Chemical     Gas Processing     Refinery     Power     Pulp & Paper

Food     Drug     Cement     Municipal     DOT Pipeline

Other:

Description of Existing Condition:

Please check all that apply.

Not Leaking     Seam Leak     Crack     Pinhole Leak

Internal Corrosion     External Corrosion

Pipe Specification:

Diameter:    Length of Flaw:    Repair Length:

Type of Steel:    Grade:    Schedule:

Component:

Pipe     Tee     Nozzle     Elbow     Tank     Other:

Temperature:

Low (°F):    Max (°F):    Constant (°F):    Cycling (°F):

Line Pressure:

Low (Psi):    Operating (Psi):    High (Psi)**:

**MAOP is the maximum allowable working pressure as defined in ASME B31G or API 579 or other calculation method.

Line Chemistry:

Type of Chemical:      Concentration: %

Measured Wall Thickness:

Current Wall Thickness (Inches):      Read Date:     

Previous Wall Thickness (Inches):      Read Date:

Span:

Maximum Un-supported Span Length:     

Pipe Coating Type:

Details of Defect Area(s)

Defect 1

        Type of Defect: Mechanical      Corrosion      Erosion

        Length:      Width:      Depth:     

        Location:      Distance from Weld:

Defect 2

        Type of Defect: Mechanical      Corrosion      Erosion

        Length:      Width:      Depth:     

        Location:      Distance from Weld:

Defect 3

        Type of Defect: Mechanical      Corrosion      Erosion

        Length:      Width:      Depth:     

        Location:      Distance from Weld:

Defect 4

        Type of Defect: Mechanical      Corrosion      Erosion

        Length:      Width:      Depth:     

        Location:      Distance from Weld:

Defect 5

        Type of Defect: Mechanical      Corrosion      Erosion

        Length:      Width:      Depth:     

        Location:      Distance from Weld:

1. Plant Shutdown     Production Loss     Environmental

2. Emergency repair:  Yes    No

3. Wrap line while in service? Yes No

4. Line pressure can be lowered during maintenance to Psi.

5. Line temperature can be lowered during maintenance to:     Low: F°   Max:

6. Surface preparation available:
   

7. Describe the type of repair:

Above ground      Below ground      Transition

8. Repair Length:

Vertical Wrap est. ft.:      Horizontal Wrap est. ft.:

9. Minimum space available for the repair:

Above:      Below:      Around:

10. Conditions at time of repair:

Pipe Temperature (°F):      Ambient Temperature (°F):

11. Wrap Schedule:

Start Date:      End Date:

12. Time allowed to complete work and return line to service:

13. Services to be provided by the Owner/Operator:

14. What is the anticipated service life of the wrap?

Total Number of Months: