ZR Number:

Chevron
LIt 16735
Inspection Release Note Copy No

Chevron Requisition and Purchase Order Vendor Details

Details
Chevron Order KCPP 41111 Name BAKER OiL TOOLS/NOV ELMAR

CItshore Location Asset: CAPTAIN Address WESTHiLL

Weil ReLAFE No KWPCA’161PLT-OO (EH; Conlact DAVE KAY

Part of Order Is order complete?

1 56 41,7 (12,5#) I3CRBQ TSP BLUE, DOPELESS BOX X PIN RANGE 3 C DUAL EXCLUDER SCREENS

SAP No. 1732355

— I —
—

I,—

This document is issued and endorsed below by the attending inspector and is a statement that the
attached work scope has been completed and that the terms and conditions of the applicable Chevron
order have been fulfilled however It does not remove responsibility from manufacturer! supplier from
ensuring correct specifications and Chevron order requirements are fully met.

Attachments to be submitted with this Release Note: (Indicate accordingly)

Chevron Order. Yes/No Test Ccrtficales Yes/No

Letter ol Conformity Yes/No nspection reports Yes/No

Material Certificates Yes/No .C.B. Release Note Yes/No

Applicable completed scopes of works. Yes

Chevroi Distribution Copy No

I Accompreny coeds
2 Vendorcopy
3 DSG CC Files

Signature/Stamp. STUART CLARK 4 Offshore

5 PelersonSBS Shipping Dept.
-

CUF.-DS-F505 Re’ 3 Pare i of I Dncsrnrri’ Owner QA.IQC Team Ldr

Dole: 29/ID/Ot Rcoc> Cycle: C] i/b rnorras.
by Chcvron Ce’corahon
onsrropr-r;irfmnan of Cherm :n C3rroror.on Ary use fh:s ti Co ner.I w haul er,r’Pn Or. WI IptflnlSS:C’II haIti
Chevron Car paiiun nd/or ha sibiLant /c mcdi b/led,
Elmar

DECLARATION OF CONFORMITY

We hereby certi& that the products detailed herein have been inspected and tested in
accordance with the conditions and requirements of the contract or purchase order and
unless otherwise noted conform in all respects to the specification(s) drawing(s)
relevant thereto,

1. Order Acknowledgement: P25349 SC 275

2, Customer Order N: 4508688433

3, Elmar Part N°: H486900157A124

4. Baker ISTO N°: 5502360538

Chevron SAP No: 1732358

ITEM QTY DESCRIPTION

1 86 4.5” TWIN EXCLUDER 316L 250 MICRON JKT

CUSTOMER SUPPLIED BASE PIPE 4.5” 12.6 LB(FT 13CR
R3 TSH BLUE DOPELESS.

B.O.T Commodity No: 11486900157A124

Assy DWG No 66777820 Rev 0.
Base pipe DWG No 66232100.1 Rev 10 .2 Rev AS
G0136600.1 Rev 1
K8043500.1 Rev 0
Filter DWG No 66769900.1 RevA2l

B.O.T. ASSY NO: 105858247

Cçs
t4,PJ%

at! -ôs

Signed Date .Lrf

David Koy’
For and on behalf of Elmar(A NOVCompany)

D.QCDM92 Rev 2.0

Elmar r

FINAL INSPECTION RELEASE NOTE

(SCREEN ASSEMBLIES)

ER 2000 316L 13CR TSH

ITEMS INSPECTED: 86 off 4.5” TWIN EXCLUD

BLUE DOPELESS BASE PIPE SC 275

ROT ISTO No: 5502360538 ROT Part No: H486900157A124

CUSTOMER: Baker Hughes P0 N°: 4508688433 OA N°: F25781

Yes No N/A To
Follow
F i. Screen jacket wrapping job card/inspection record x
complete?
2. Drilling job card/inspection record complete? x

3. Final screen assembly job card/inspection record x

complete?
4. Weld NDT? x

5. Thread inspection? x

I 6. Visual inspection for sfraigbtness? x

Stamping/marking requirements correct? x

j 7.
8. Crating/marking requirements correct? x

9. Equipment ready to ship? x

10. All outstanding nonconformanc&s closed out?

The components and assemblies h been inspected and tested ensuring that our reputation for
e intended and can be
providing quaJity—prducts is m ntained. çhc equipment is fit for the purpos
despatched t’the cust r \
Signed ..i.
Elmar Screen iãppmg p nt
Date ..2L1Q

NOTES:
c— (}
CtnL
ctc GiL
a -‘cr2Ot
SWD-0l0 Rev 2.0
Aberdeenshire, A832 eTa, Scotland, UK
LUnar, Enterprise Drive, Westhill Industrial Estate, Westhill,
ml: + (44)1224740261 Saies: + (44) 1224 748700 Fax: + (44)1224 743138
Emaü: sales@elmar.co.uk