Vermont Gas System Quality Control

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Service & Meter

• Add location
  Address

• Is the riser straight and adequately supported?

  Yes

  No

  N/A

• Is the PE riser's label above grade finish?

  Yes

  No

  N/A

• Is the meter bar and meter adequately supported? "See engineering standards"

  Yes

  No

  N/A

• Does the meter set require paint?

  Safe

  At Risk

  N/A

• Is meter pad in place?

  Yes

  No

  N/A

• Is there hazardous predatory vegetation?

  Safe

  At Risk

  N/A

• Add media

  Media

Outlet Piping

• Is piping adequately supported? (See engineering standards".

  Yes

  No

  N/A

• Is outlet piping wall penetration sleeved or sealed?

  Yes

  No

  N/A

• Add media

  Media

Meter/Regulator Roof

• Does meter/regulator require a roof cover?

  Safe

  At Risk

  N/A

• Add media

  Media

Vehicular protection

• Is meter within 3 feet of the driveway? Is protection required?

  Safe

  At Risk

  N/A

• Add media

  Media

Inspector

• Clock #

  280 - Sheila Ashline

  329 - Dave Attig

• Select date

  Date

• Add signature

  Sign