Pressure Vessel Hydrostatic Test Report

NASA Glenn Research Center

WELD REQUEST NUMBER:
(N/A for non PSO Related)

VESSEL DESCRIPTION HYDROSTATIC TEST PARAMETERS

1. MANUFACTURER: 1. HYDROSTATIC TEST DATE:

2. MODEL NUMBER: 2. MAXIMUM TEST PRESSURE, PSIG:

3. MAWP, PSIG: 3. TEST FLUID:

4. TEST FLUID TEMPERATURE, F:

5. VESSEL METAL TEMPERATURE, F:

6. VERIFIED GAUGE CALIBRATION DATE:

OTHER REQUIREMENTS
1. RESTRICTED AREA, FT:

2. COLD SHOCK (CRYO ONLY) Y/N, DATE:

3. LEAK TEST (REQUIRED) Y/N, DATE:

SPECIFIC CHECK POINTS, % OF MAXIMUM PRESSURE TIME/INITIALS

1. 50% = HOLD TIME

2. 60% = HOLD TIME

3. 70% = HOLD TIME

4. 80% = HOLD TIME

5. 90% = HOLD TIME

6. 100% (max) = HOLD FOR 15 MINUTES

REMARKS:

HYDROSTATIC PRESSURE TEST PERFORMED BY:

ORGANIZATION

TECHNICIANS
SIGNATURE DATE

SIGNATURE DATE

NASA WITNESS
SIGNATURE DATE

OTHER
SIGNATURE DATE

NASA C-4016 (MAY 2012)