System Mechanical Site:

GFR Handover No: Completion No:

Intrusive Work WCC No: Procedure 3.1.1 ‘Complete Joint Integrity’ Yes/NA Sign Print

Work Order: Location: - PAGA Isolation ICC No: Personnel Procedure 3.1.3 ‘Complete Cleaning & Flushing’ Yes/NA Sign Print RAVEN GF

Operations System:
Work pack
E-24 Lubricant Used*: Leak Test/Service Test WCC No: Procedure 3.1.6 ‘Complete Piping Completion’ Yes/NA Sign Print
NUMBER OF PACK:
Liquid Check on Suction of FGC T2 Workpack No: Leak Test ICC No: (If Applicable): Procedure 3.2.3 ‘Complete Witness Joint’ Yes/NA Sign Print
Title:

DEC 20 Joint TAG Location Drawing(s) to be attached to this Certificate Procedure 3.2.4 ‘Complete Service test’ Yes/NA Sign Print

Originated By: M.Beshara Date: 02/12/2021 Checked By: Date: Leak Test Medium and Pressure:- Test Medium: Target Pressure: Test Accepted Y/N: Name: Signature: Date: SHT 1 of 1

SUPERVISED ASSEMBLY OR PART C

Please state reason for Break Out Request: Taking oil sample PART A Installation WITNESS JOINT
PART B – Leak Test
Operational Phase
Flange Bolt Ø Flange
P&ID No Flange Type Tensioning Joint Broken and Inspected Joint Assembled and inspected Joint Tightened ** Name Joint Checked By (Name) 48 Hour
Size (NB) (inches) Hydraulic Tool Details Face N/A Service Test
Joint Torque Value Residual Bolt 12 Hour 24 Hour 36 Hour Check and
TAG ID Bolt Bolt Qty Bolt/Nut Material Name Defect Name Completion Name S/A Start-Up
Criticality NM / lbs. Ft Stress Actual Torque / Tensioning Date Joint Check Check Check Tag
Additional Details (Iso No./Joint Ref) Rating Length Gasket Type Signature Date Identified Date W Signature Signature Date
Tool Ref Pass PSI (lbs/in2) Signature Value + Units Completion Signature Completed Removed
(mm) (Y/N)

EG001-PE-PID-11E-24-
1” 5/8 RF
0202-001 A320-L7/
4 90
A194-4L
J1 HV-3898 300 80 SWG
EG001-PE-PID-11E-24-
1” 5/8 RF
0202-001 A320-L7/
4 90
A194-4L
J2 HV-3899 300 80 SWG
EG001-PE-PID-11E-24-
1” 5/8 A320-L7/ RF
0206-001 4
A194-4L 90
J3 HV-3907 300 80 SWG
EG001-PE-PID-11E-24-
1” 5/8 RF
0210-001 A320-L7/ 90
4
A194-4L
J4 HV-3944 600 90 SWG

     

Operations to complete Post System acceptance: - Part C Start-Up Scope, MUST be completed and accepted
* Bolt Lubricant to be used for Torque Tightening Parts A & B to be completed before SH1 can be signed and 'Start-Up' executed
before Plant can be operated safely without jeopardizing personnel, plant, or the environment.

TAG ID DATE REPAIRED ACCEPTED BY SIGNATURE ` PART A COMPLETED BY PART A APPROVED BY PART B COMPLETED BY PART B APPROVED BY PART C COMPLETED BY PART C APPROVED BY Originator Verified

COMPANY           Raised By: Raised By:

SIGNATURE           Print Name: Print Name:

PRINT NAME           Sign: Sign:

DATE           Date: Date: