UNDERGROUND PIPING TEST QCDD FORM

PINNo. 94021268 Date 20-10-2022

Location MESSAIEED INDUSTRIAL CITY Application Number
Project Name GEOGREEN SHIELD OIL REFINERY PROPOSED EXTENSION (ADDITIONAL REFINERY BLDG,ADMINISTRATION BLDG. & FARM TANK AND MODIFICATION OF MAINTENANCE BLDG.)

Owner GEOGREEN SHEILD OIL REFINERY

QCDD Approved Drawing Ref. No. M/2021/001127

Test Status Passed ✔

SYSTEM INFORMATION
Location Supplies Building NEW FACTORY LAY-OUT
Hydrostatic Test _____PSI(Bar)
200 Duration: 2 Hrs
UNDERGROUND REQUIREMENT
YES N/A
Operational instructions are in place. ✔
Flushing has been done in accordance with NFPA 13/NFPA 24 ✔
All piping and attached appurtenances had been hydrostatically tested at 200PSI or 50PSI in excess
of system working pressure, whichever is greater and shall maintain that pressure(+/-)5PSI for 2 ✔
hours.
Installation and testing conforms to approved plan and NFPA Standard. ✔
Forward flow test of backflow preventer has been performed in accordance with NFPA 13/24
requirements. ✔
Leakage test has been done ✔
Water Control Valves left wide open ✔
Fire department connections and hydrants shall be in BS336 standard. ✔
All underground pipes, joints and fittings used conforms with the approved plan, NFPA
Requirement and with CDD product approval. ✔

CERTIFICATION
The system as specified above has been installed and tested, in accordance with latest edition of NFPA, QCDD FSS and QCDD
approved drawings.

______________________
Sakthivel Sellamuthu 56074/29435616287/+974 31113404
_______________________________________________
Contractor (QCDD Certificate No. / ID No. / Mobile No.)
(Signature over Printed Name with Company Stamp)

CERTIFICATION
The undersigned accepted the installation and testing of the system as specified above.

________________________ _______________________________________________
Consultant (UPDA No. / ID No. / Mobile No.)
(Signature over Printed Name with Company Stamp)
Note: All fields are mandatory

Page1 of 1