LRUT JOB PREPARATION QUESTIONNAIRE

Long Range Guided Wave Inspection

The purpose of this form is to allow Velosi to assess the application / suitability for Long Range Guided
Wave examination and to allow us to estimate the expected performance and provide precise systematic
reporting. The form will also ensure that the equipment required for the testing is properly selected, and set
up prior to the execution date.

Accurate completion of this form will help make the work on site more efficient and provide better
inspection and markation of the datum, and as such we ask that you answer as many of the questions as
possible in order to gain the most benefit from the process.

We appreciate your response to this questionnaire at least two weeks prior to the projects mobilization to
allow for quotation time and scheduling i.e. Inductions required, Inspection access requirements, etc.

Customer Information:
Client/Company Name
Client Representative Name
Phone No.
E-mail
Report Requirements Prelim report Choose an item.
Final report Choose an item.
Electronic Copies
Choose an item.
Required

Facility Information:
Facility Name
Site Contact Name
Phone No.
E-mail

LRUT JOB PREPARATION QUESTIONNAIRE Page 1 of 4

Item Information:
Plant or Unit #
Line Name and no.
Year Built or Installed
Pipeline Material Choose an item. Other (specify)
Service/ Product
Outside Diameter (O.D.) Choose an item. Other (specify)
Choose an item. Other (specify)
Choose an item. Other (specify)
Choose an item. Other (specify)
Choose an item. Other (specify)
Choose an item. Other (specify)
Design of Pipe Wall
Choose an item. Other (specify)
Thickness Schedule
Is the O.D. / WT constant
Choose an item.
throughout the line?
Temperature during
Choose an item.
Examination
Length (approximate)
Are there other features Weldolet Choose an item.
on the pipe?
Branches Choose an item.

Valves Choose an item.

Others
Frequency of elbows/
bends over proposed
inspection range
Bend/ Elbow Type Choose an item. Other (specify)
Is the Pipe Buried? Choose an item.
If buried, is excavation for
Choose an item.
inspection possible?
Is scaffolding required to
Choose an item.
access the pipes?
Joints Choose an item. Other (specify)

LRUT JOB PREPARATION QUESTIONNAIRE Page 2 of 4

Insulation/Coating Information:
Is the Pipe Insulated? Choose an item.
Coating Type Choose an item. Other (specify)
Coating Condition Choose an item. Other (specify)
Insulation Choose an item. Other (specify)
Can insulation be removed locally in
at least 500mm long sections to Choose an item.
facilitate probe placement?

Wrapped Pipe:
Is the Pipe Wrapped? Choose an item.
Type Choose an item. Other (specify)
Condition Choose an item.

Wall Penetrations:
Are Wall Penetrations present? Choose an item.
Type of Wall Choose an item. Other (specify)
Wall Width/Length (approximate) Choose an item.

Known or Visible Corrosion:

External Corrosion/ Pitting (known)
Choose an item.
(leave blank if unknown)
External corrosion/ Pitting
Choose an item.
Distribution
Internal Corrosion (known)
Choose an item.
(leave blank if unknown)
Internal Corrosion/ Pitting
Choose an item.
Distribution

Pipe Supports:
Basic Configuration Choose an item.
Support Type
Choose an item. Other (specify)

Frequency of Supports

LRUT JOB PREPARATION QUESTIONNAIRE Page 3 of 4

Vibration:
Service Status Choose an item.
Is the line located on pipe racks
Choose an item.
containing vibrating pipes?
Is the line able to be shut down
during the inspection if vibration is Choose an item.
excessive?

Inspection History (not already detailed) : (A brief description of equipment service history/problems that
might assist us in determining defect mechanisms i.e. results from previous examinations,
repairs/alterations performed, notes/comments or lab results from operations etc.)

Purpose of examination: (The suspected deterioration mode; CUI, internal corrosion/erosion etc. and if
there are unique problems.)

Please provide an electronic copy, fax copy, or courier a copy of the Manufacture/Fabrication drawing,
Isometric sketch or As Built drawing of the equipment that contains the following examples: (to scale if
possible)
- Test Areas (hatch test areas if a partial test is required).
- Line Numbers, Meterage, Elevation, Associated Equipment, Orientation, etc.
- Location of Welds, Seams, Nozzles, Reinforcement Plates, Vessel Skirt, etc.
- External Attachments, Deck/Platform levels and Insulation/Stiffing Rings, etc.
- Internal Components, Trays, Downcomers, Clip Attachments, etc.

If you have any questions, concerns, or require assistance in completing the information, please do not
hesitate to contact us at your convenience!

Respectfully,

PT. BILL EMAS SARNO

LRUT JOB PREPARATION QUESTIONNAIRE Page 4 of 4