Chaparral Energy Catholic Protection Survey Report_2

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Survey Information

• Employee Name

  Sign

• Pipeline System Name

• Meter Serial #

• Reference Cell Type

  Select Cu/CuSo4 Ag-AFCI Zn-ZnSO4

  • Cu/CuSo4
  • Ag-AFCI
  • Zn-ZnSO4

• Soil Type

• Soil Condition

Test Stations

Test 1

• Location

• Test Station #

• LAT/LONG
  Address

• P/S Reading

• Casing Volts

• Carrier Volts

• Picture(s)

  Media

Test 2

• Location

• Test Station #

• LAT/LONG
  Address

• P/S Readings

• Casing Volts

• Carrier Volts

• Picture(s)

  Media

Test 3

• Location

• Test Station #

• LAT/LONG
  Address

• P/S Readings

• Casing Volts

• Carrier Volts

• Picture(s)

  Media

Test 4

• Location

• Test Station #

• LAT/LONG
  Address

• P/S Readings

• Casing Volts

• Carrier Volts

• Picture(s)

  Media

Test 5

• Location

• Test Station #

• LAT/LONG
  Address

• P/S Readings

• Casing Volts

• Carrier Volts

• Picture(s)

  Media

• Supervisor's Signature

  Sign

• Date

  Date