Form No.

: FM/JCI/CON/PQP/001-026Rev-00
Test No. : 001 /TES-WELD/JCI-AKD/VIII/2017
TEST WELDING REPORT Project :
Date : 14 Agustus 2017

Project Name Date : 14 AGUSTUS 2017

Location Drawing Ref :

EQUIPMENT & MATERIAL DATA

- Machine Type
- Electrode
- Ampare : 10 A - 120 A
- Pipe Type : BLACK STEEL SPINDO, SCH -40, DIA 4"

TEST RESULT

Ampere : 95 Ampere

No. Leak : Yes No

Test Result Equipment Test Remarks & Command

Approve
Approve As note
Repeat Test

Disetujui Oleh, Diketahui Oleh, Dilaksanakan Oleh,

( ) ( ) ( )
PM / SM / QC