Quality Assurance Inspection Form - Surface Preparation: Conductivity Log
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1Appendix 4 - Quality Assurance Inspection Form – Surface Preparation: Conductivity Log
SHEET: ____of____
NAME & HULL #: ___________________________________________ CONTRACT/TASK ORDER/CLIN/TWD: ____________________________________________
LOCATION OR TANK: _______________________________________________________ WORK ITEM: ____________________________________________________
REQ’T DOCUMENT: _________________ FY: ___________ TABLE: ____________ LINE: _____________ COLUMN: _______ (I)
(V)
(G)
(N/A)
_____________________________
CONTRACTOR: PRIME: _________________________________SUB:_____________________________NAVAL FACILITY:
Chloride/
Chloride/
QA Equipt
Conductivity
QA Equipt
Conductivity
No. from
Area/Location
No. from
Area/Location
Reading
Reading
App. 2
App. 2
μg/cm
2
μg/cm
2
μS/cm
μS/cm
[1]
[1]
(I) Quality Assurance Inspector Signature & Date
:
(G) Quality Assurance Inspector Signature & Date
:
Sat
Unsat
Remarks (continue on back if needed)
See back for Continuation:
[1
Signature certifies, based on personal observation, that the data entered above is complete and accurate. Signature includes at least first initial, last name, badge/employee number, or inspector certification number, and date.
[2]
For electronic equipment that accumulates information in batches and self averages, it is acceptable to enter only the average of the readings for each spot.
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