Chaparral Energy Maintenance Record/Atmospheric Corrosion Inspection

• Faculty/Line Segment

• Conducted on

  Date

• Prepared by

• Location
  Address

• Check all boxes that apply.
  This Report covers:

• Permanent Repairs (sections A, B & E)

• Test Point Installation (sections A, B & E)

• Visual Pipe Inspection (sections A, B & E)

• Stations (sections A & D)

• Valves (sections A & D)

• Exposures (section A & C)

• DOT

  Select Yes No

  • Yes
  • No

• Date of Report

  Date

• Date Completed

  Date

• Report #

• Line Segment/Description

• Township/Legals

• LAT/LONG
  Address
• County/State
  Address

• Type of Service

  Select Gas Crude CO2

  • Gas
  • Crude
  • CO2

• Line Size

• Final Line Depth

Section A: Coating and Pipe Condition

• Condition of Pipe and Coating

  Select Generally Corroded Isolated Pitting No Corrosion Bonded

  • Generally Corroded
  • Isolated Pitting
  • No Corrosion
  • Bonded

• Paint Condition

  Select Ok Requires Painting

  • Ok
  • Requires Painting

• Pipe-to-Soil Transistion

  Ok

  Requires Repair

• Coating Applied

  Select Yes No

  • Yes
  • No

• Condition of Coating

  Select Good Poor Brittle Wrinkled Soil Penetration Cracked

  • Good
  • Poor
  • Brittle
  • Wrinkled
  • Soil Penetration
  • Cracked

• If the line was cut, what was the condition of the internal surface?

  Select Generally Corroded Isolated Pitting No Corrosion Bonded

  • Generally Corroded
  • Isolated Pitting
  • No Corrosion
  • Bonded

• Type of Existing Coating

  Select Asphalt Coal Tar Epoxy Plastic Tape ACM None Other

  • Asphalt
  • Coal Tar
  • Epoxy
  • Plastic Tape
  • ACM
  • None
  • Other

• If "other" please explain

• Type of Coating Applied

  Select Asphalt Coal Tar Epoxy Plastic Tape ACM None Other

  • Asphalt
  • Coal Tar
  • Epoxy
  • Plastic Tape
  • ACM
  • None
  • Other

• If "other" please explain

Section B: Corrosion

• SCC Performed

  Select Yes No

  • Yes
  • No

• Catholic Protection

  Select Anode Rectifier None

  • Anode
  • Rectifier
  • None

• Maximum Pit Depth

• Length of Longest Pit

• Longitudinal/Axis Length

• If there is internal corrosion, how much wall lose?

• Damage to Company Pipeline?

  Select Yes No

  • Yes
  • No

• Date of Spill Report

  Date

• Hydro Test Report

Section C: Washouts and Erosion

• Nature/Reason for Exposure

• Length of Exposure

• Is Exposure Increasing?

  Select Yes No

  • Yes
  • No

• Is Pipe Suspended?

  Select Yes No

  • Yes
  • No

• If "yes" please state length suspended

• Is Exposure in Waterway?

  Select Yes No

  • Yes
  • No

• If "yes" please state the waterway's name

• Is Exposure in High Impact Area?

  Select Yes No

  • Yes
  • No

• If "yes" please describe

• Exposed Coating Condition

  Select Ok Damaged Disbonded Other

  • Ok
  • Damaged
  • Disbonded
  • Other

• If "other" please explain

Section D: Pipe Supports

• General Condition of Pipes

  Select Ok Requires Repair

  • Ok
  • Requires Repair

• Type of Support

• Problem Location
  Address

• Insulation

  Select FRP None

  • FRP
  • None

• FRP Condition

  Select Ok Other

  • Ok
  • Other

• If "other" please explain

Section E: Soil Conditions

• Soil Type

  Select Clay Loam Rock Sand Silt Other

  • Clay
  • Loam
  • Rock
  • Sand
  • Silt
  • Other

• If "other" please explain

• Drainage

  Select Good Fair Poor

  • Good
  • Fair
  • Poor

• Land Use

  Select Cultivated Pasture Wooded Other

  • Cultivated
  • Pasture
  • Wooded
  • Other

• If "other" please explain

• Backfill

  Select Loose Settling Solid Other

  • Loose
  • Settling
  • Solid
  • Other

• If "other" please explain

• Topography

  Select Level Rolling Rough River Bottom Swampy Other

  • Level
  • Rolling
  • Rough
  • River Bottom
  • Swampy
  • Other

• If "other" please explain

• Tests

  Select Wet Dry

  • Wet
  • Dry

• Pipe/CuSO4

• Over Pipe

• Under Pipe

• Ground Level

• Soil PH

• At Pipe Level

• Remarks:

• Picture(s)

  Media

• Employee Signature

  Sign

• Date

  Date

• Supervisor Review Signature

  Sign

• Date

  Date