PRESSURE EQUIPMENT INTEGRITY MANAGEMENT PROGRAM

Ultrasonic Inspection Report Exhibit #9200

Revision 0 April 23, 2015 Page 1 of 3

ULTRASONIC INSPECTION REPORT Report #:

Client: Invoice Address: Work Location: Procedure: Accept. Standard: EXAMINATION OF:

Job #: Date: P.O. #: W.O. #: Page of

ULTRASONIC EQUIPMENT

Flaw Detector:

Make: Model: Serial Number: Cal. Date:

Cal Block(s):

1: SN:

2: 3: SN: SN:

Transducers:

Transducer Angle

Frequency MHz

Crystal Size Crystal Type Single/Dual

Serial No. Primary Reference Gain dB

Scanning Gain dB

Time Base Range (mm)

Scanning Limitations:

Transfer Value:

TECHNICIAN(S) Interpretation is in accordance with the above mentioned standards, to the best of my professional ability. Tech-1: __________________ CGSB Level: _______ Reg. No: ____________ Sign: ____________________ Tech-2: __________________ CGSB Level: ________ Reg. No:_____________ Sign: ____________________ Clients Representative(Print)___________________________ Sign: _______________________ Date: _______

PRESSURE EQUIPMENT INTEGRITY MANAGEMENT PROGRAM

Ultrasonic Inspection Report Exhibit #9200

Revision 0 April 23, 2015 Page 2 of 3

Scope:

Results: