Cathodic Protection

Valve Jumpers / Bonding QC-195G

&Release
CONTRACT# CLIENT / PROJECT SYSTEM

JOB# CWP

CLIENT REF:
Mark “N/A” where Not Applicable
Drawing and Rev :

Valve / Inspected By
Bond/Jumper Bond/Jumper Continuity
Valve or Pipe Flange ID Installed Connected Check
Flange Left
Continuous Initial Date

COMMENTS:

INSPECTED BY CHEMCO CLIENT OTHER

NAME: NAME: NAME: NAME:

SIGNATURE: SIGNATURE: SIGNATURE: SIGNATURE:

DATE: DATE: DATE: DATE:

Revision 0 July 6, 2006 QC-195G R0 Cathodic Protection Bonding & Release.doc Page 1 of 1