Doc No F-ASE-QHSE-39

VALVE GREASING REPORT Revision 00

Date 16-Oct-19

Project Information Product Information Grease Specification

Date : Serial Number : Brand :
Location : Brand : Type :
Project Name : Valve Type : Color :
Area : Size / Class : Temperature Range :
Facility : Connection : Base Oil :
End User : Operator : Penetration :
Remark Oprtg Prss. & Temp. : psi / deg. C Volume :
Operating Fluids : Remark
Valve Status : Offline / Online

Documentation
A. Initial Condition

(Attach Photo) (Attach Photo) (Attach Photo)

Side (A) Center Side (B)

(Attach Photo) (Attach Photo) (Attach Photo)

Leakage Evidence (Passing) @ Shut Off Position - Pic.1 Leakage Evidence (Passing) @ Shut Off Position - Pic.2 Leakage Evidence (Passing) @ Shut Off Position - Pic.3
 Doc No F-ASE-QHSE-39
VALVE GREASING REPORT Revision 00
Date 16-Oct-19

Documentation
B. Greasing Process

(Attach Photo) (Attach Photo) (Attach Photo)

Upstream - Preparation Downstream - Preparation Gear Lubrication (Additional) - Preparation

(Attach Photo) (Attach Photo) (Attach Photo)

Upstream Downstream Gear Lubrication (Additional)

Injection Report - Upstream Injection Report - Upstream Injection Report - Gear

Total Shoots : times Total Shoots : times Total Shoots : times
Total Grease Injected : gr.(Approx.) Total Grease Injected : gr.(Approx.) Total Grease Injected : gr.(Approx.)
Any Return? (Yes/No) : Any Return? (Yes/No) : Any Return? (Yes/No) :
Remarks : Remarks : Remarks :
 Doc No F-ASE-QHSE-39
VALVE GREASING REPORT Revision 00
Date 16-Oct-19

Documentation
C. Post-Process

(Attach Photo) (Attach Photo) (Attach Photo)

Fully Sealed - Pic.1 Fully Sealed - Pic.2 Time Holding - Pic.3

Summary

Operator, Inspected By, Approved By,

PT. Arflu SE PT. Arflu SE