CERTIFICATE NO :

SAFETY RELIEF VALVE WORKSHEET VALVE TAG NO :

PREVIOUS CERT NO :
CUSTOMER / YARD NO :
CUSTOMER : ORDER NO :
PRE - POP TEST DETAILS
VALVE TAG DETAILS C.D.S.P. 3 sets 1)

MAKE SIZE IN / OUTLET 2) 3)

STYLE RATING IN / OUTLET LEAKAGE RATE :

SHOP NO OPT. TEMP. BLOWDOWN % :

SERIAL NO ORIFICE CURRENT SPRING NO :

NAME PLATE SET PRESSURE BACK PRESSURE SPRING RANGE :

NEW SET PRESSURE REQUIREMENT

TEMPERATURE CORRECTION FACTOR TEST BENCH # :

RATED CAPACITY TEST STANDARD : API 527 / OEM

VALVE TYPE: CONVENTIONAL / BELLOWS / OPEN BONNET CLASSIFICATION: SEC VIII / SEC I / NS TEST MEDIUM N2 / H20 / Air

TEST DETAILS REQUIREMENTS RESULTS

COLD DIFFERENTIAL SET PRESSURE

SEAT TIGHTNESS TEST PRESSURE
LEAKAGE RATE
BACK PRESSURE TEST
BLOWDOWN SETTING %
TEST GAUGE DETAILS
CALIBRATION DATE : MAKE : BOURDON UNITS : BOURDON S/N :
CERTIFICATE NO : TYPE : BOURDON TUBE RANGE : Bourdon Tube OWNER : VALSER
VALVE STATUS
1) VALVE GOOD - C.S.P.
C S P WITHIN TOLERANCE
TOLERANCE. NO ADJUSTMENT IS REQUIRED
2) VALVE GOOD BUT C.S.P. OUT OF TOLERANCE. VALVE RECALIBRATED
3) VALVE PASSED POP TEST, BUT FAILED SEAT LEAKAGE TEST, SO REQUIRED OVERHAUL
4) VALVE FAILED POP TEST AND SEAT LEAKAGE TEST, SO REQUIRED OVERHAUL
5) VALVE PASSED POP TEST AND SEAT LEAKAGE TEST, BUT STRIPPED FOR INSPECTION AND OVERHAUL
6) NO PRE-POP TEST, VALVE STRAIGHT OVERHAULED
7) OTHERS (PLEASE SPECIFY)
RECEIVED CONDITION :
1. General Apperance: (a) Rusty (b) Greasy (c) Falling Paint (d) Old & dirty (e) Loosely assembled (f) New Valve (g) Missing parts, specify
(h) Outlet flange/thread (i) Spindle nut (j) Cap (k) Gaskets, Specify Others :
2. Damaged Parts: (a) Spring (b) Spindle (c) Guide (d) Piston (e) Liner (f) Nozzle (g) Bonnet (h) Body (i) Inlet flange/thread (j) Outlet flange/thread
(k) Dipper Tube (l) Spindle nut (m) Retainer (n) Adjusting bolt (o) Cap (p) Gaskets, Others:
3. Type of damaged: (a) Broken (b) Cracks (c) Cuts (d) Chipped (e) Rusty (f) Hammer marks (g) Galled (h) Bent (i) Fatigued, Specify others:

4. Seats Condition: (a) Broken (b) Cracks (c) Cuts (d) Scratched (e) Pitted (f) Worn, Specify others:

Nozzle Seat Step

FINDINGS AND REMEDIES :

1. Failure Causes: (a) Damaged Seats (b) Parts misallignment (c) Damaged parts (d) Incorrect calibration (e) Sitcky guiding surfaces (f) Missing parts,
(g) Chattering (h) Flattering (i) Others
2. Actions Taken: (a) Nozzle lapped and polished (b) Damaged parts replaced (c) Damaged parts repaired/machined (d) Replaced Spring
Replacement New Spring No : Other Replacement Part No :
4. Other Comments :

Valve Received Date : Tested On :

TESTED BY : WITNESSING AUTHORITY :
APPROVED BY :
PT VALSER INTERNUSA NAME :
WORK INSTRUCTIONS INSTRUCTION BY REMARKS

Witnessing Required Oxygen service

Others to be specified
Legend :-P/P - Pre-Pop, S/I - Strip & Inspect, O/H - Overhaul, T/C - Test & Certify
Page 2

Quality Control Section Job No.: Tag No. :

WORK PERFORMED ON COMPONENT PARTS

ITEM COMPONENT GOOD MACHINE RENEW REPAIR COMMENTS
1 Inlet Flange / Thread
2 Outlet Flange / Thread
3 Nozzle Base
4 Nozzle Seat - Metal / Resilient
5 Nozzle Ring
6 Disc - Metal / Resillient
7 Disc Holder / Guided Stem
8 Guide
9 Guide Ring
10 Spindle
11 Spring / washers
12 Adjusement Bolt
13 Body Fasteners / Threads
14 Bellows Assembly
15
16
17
18
19
20
21
22
23
24
25

REWORK ORDER
Causes for Rework Details
Leakage rate exceeded alowable rate Dismantle, Overhaul and Re-test
Improper operating characteristics Others:
Improper handling
Others

Instruction By : Performed By :
Signature / Date Signature / Date
Next Causes for Rework Details
Leakage rate exceeded alowable rate Dismantle, Overhaul and Re-test
Improper operating characteristics Others:
Improper handling
Others

Instruction By : Performed By :
Signature / Date Signature / Date
Remarks:
 WORK INSTRUCTIONS

1.
Initial : Date :
2.
Initial : Date :

Inspection Details

Item Condition Action New

Bonnet Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Body Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Spring Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Spindle Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Disc Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Nozzle Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Bellows Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Guide Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Blowdown Ring Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Adjusting Screw Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine
Other Bent/Fair/Good/Poor Adjusted/Clean/Lap&Polish/Machine

Critical Dimension Inspection

A
C

Dimension Required Result Remarks

"A"
"C"

Remarks / Recommendations / Additional Parts

Stripped by : Date :
Inspected by : Date :
Re-Inspected by : Date :
Re-Built by : Date :