UA WELDING CONTINUITY FORM

CONTRACTOR/ATR:__________________________
PHONE:_______________
WELDERS NAME:____________________________
SSN:__________________
WELDER SIGNATURE:________________________
LOCAL:_______________
ADDRESS:_____________________________________________________________
_______________________________________________________________________
__

WELDER/BRAZER CONTINUITY INFORMATION

WELDING PROCESS
GTAW(Manual Tig Arc Welding
GMAW ( Mig Machine)
SMAW (Stick)
TB
OTHER

LIST LAST DATE PROCESS USED/TESTED

WE CERTIFY THAT THE STATEMENTS MADE ON THE RECORD ARE CORRECT.

SIGNATURE:___________________________ ( )ATR ( ) CONTRACTOR

DATE:______________

WELDER ID NO: _______________________________

Please mail this completed form to:

PLUMBERS & PIPEFITTERS LOCAL UNION 123

Attention: Randy Gandy
3601 N. McIntosh Rd.
Dover, FL 33527
Phone: (813) 754-4065
Fax: (813) 659-2184