Gas
Distribution Inspection and Leakage Repair
Form 3
COMPANY: Grade of
Leak Case
ADDRESS: Grade I
Grade II
Grade III
|
SKETCH SHOWING LEAKS LOCATED |
METER
SET |
|
|
Meter No. (if
inspected) |
LEAK DATA
|
Detected By |
|
Collecting |
|
Probable Source |
|
C.G.I. Test |
|
|
Mobile
Flame Pack |
|
In
Building |
|
Mainline |
|
Gas
Percent (%) |
|
|
Flame
Pack |
|
Near
Building |
|
Service
Line |
|
L.E.L. |
|
|
Visual/Vegetation |
|
In
Manhole |
|
Service
Tap |
|
P.P.M. |
|
|
Combustible
Meter |
|
In
Soil |
|
Valve |
|
Negative |
|
|
Odor |
|
In
Air |
|
Meter
Set |
|
|
|
|
Bar
Hole |
|
Other |
|
Tee |
|
|
|
|
Pressure |
|
Surface |
|
Leak Course |
|
|
Low |
|
Lawn |
|
Corrosion |
|
|
Intermediate |
|
Soil |
|
Outside
Force |
|
|
High |
|
Paved |
|
Construction
Defect |
|
|
|
|
Other |
|
Material
Failure |
|
|
|
|
|
|
Other |
|
|
Component |
Explanation |
Part of System |
|
Pipe Type |
Size |
Year Installed |
|
Pipe |
|
Main |
|
Steel |
|
|
|
Valve |
|
Service |
|
Cast
Iron |
|
|
|
Fitting |
|
Meter
Set |
|
Plastic |
|
|
|
Drip |
|
Customer
Piping |
|
Other |
|
|
|
Drip
Connection |
|
Other |
|
|
|
|
|
Regulator |
|
|
|
|
|
|
|
Other |
|
|
|
|
|
|
Pipe Condition: Good: Fair:
Poor:
Coating Condition: Good: Fair:
Poor:
Date Repaired: Date Rechecked:
Remarks: