Engineering Assessment Form

ENGINEERING ASSESSMENT FORM

** To ensure accuracy, complete EAF in its entirety. Worst case will be assumed for any fields left blank. Include pictures when available. ** CONTACT INFORMATION ASSET OWNER: SERVICE CONTRACTOR: EAF COMPLETED BY: City: State: City: State: Phone: Contact: Contact: Email: Phone: Phone: NRI Distributor: Email: Email: (company name) Location of line: Job#: Line ID#: Scheduled start date: REQUIRED INFORMATION Calculation package requirement: Preferred composite system, if within Preferred filler, if within scope: P ☐ ASME PCC-2 compliant scope: ☐ Syntho-Steel R E ☐ Non-ASME PCC-2, engineered ☐ Syntho-Glass XT ☐ Syntho-Poxy HC F ☐ Viper-Skin E ☐ ISO 24817 compliant ☐ Thermo-Fill R ☐ Best effort recommendation ☐ Thermo-Wrap ☐ Thermo-Fill HT E N ☐ Thermo-Wrap Inspectable (2X ☐ No preference C thick) E S ☐ Thermo-Wrap CF ☐ No preference Nominal pipe size (OD): Will the line be depressurized during PRESSURE P Nominal wall thickness: ☐ ☐ I Design: Operating: repair? Yes No P Geometry: ☐ Straight ☐ Tee ☐ Allowable downtime: E I Elbow TEMPERATURE N Design: Operating: Will the pipe surface be dry during F repair? O Skin temperature during installation: ☐ Yes ☐ No

D Axial length of defect: E ☐ External corrosion / damage Wall loss: % ” F Circumferential width of defect: E C Desired repair length: ☐ Internal corrosion / damage Contents of pipe: Concentration: T Intended service life of repair: I Is the line leaking: ☐ Yes ☐ No If yes, dimensions of stop gap: N F (Example: 3/8” wide stainless banding w/ 1”x1” rubber patch) O Refinery Specific: Pipeline Specific: A Allowable stress: SMYS of pipe: ☐80k ☐75k ☐72k ☐70k ☐65k ☐60 ☐56 ☐52k ☐42k D D (If unknown, 15ksi will be used) ☐35k ☐30k ’ L Repair location classification factor: ☐0.72 ☐0.65 ☐0.6 ☐0.5 ☐0.4

I Liquid Lines: # of pressure cycles per year: N F Max cycle pressure: Min cycle pressure: O Describe any conditions that may affect the installation:

of 2 Form Number: 1005 Revision: 7 Release Date: 09.25.14 ENGINEERING ASSESSMENT FORM

SURFACE PREPARATION Abrasive blasting in accordance with SSPC-SP10 “NACE 2 Near-White Blast Cleaning” is preferred, however, at a minimum, surface preparation shall be in accordance with SSPC-SP1 “Solvent Cleaning” and SSPC-SP11 “Power Tool Cleaning to Bare Metal” with a 1-3 mil surface roughness (25-76 microns) minimum. If the condition of the pipe, including defect area, does not allow for SSPC-SP11, please explain:

** Include photos and / or sketch when possible ** Use page 2 if multiple defects are present ** Send completed form to [email protected]

of 2 Form Number: 1005 Revision: 7 Release Date: 09.25.14 ENGINEERING ASSESSMENT FORM

MULTIPLE DEFECT INFORMATION Linear Size of Defect Cause of Defect Type of Defect Leaking or Blow, Defect Location Distance Wall Length (Length x (Mechanical, Int/Ext (Corrosion, Dent, Non- Spray, # (o’clock) from Weld Loss Available Width) Corrosion) Gouge) Leaking Drip

Identify each defect by placing the corresponding Defect # on sketch below. ** Please specify distance between defects. ** ** Include pictures when available.

INSTALLATION TOOLS Would you like any of the following surface prep, or application tools shipped with the composite repair materials? Rough Boy Sparkless Grinder: ☐ Yes ☐ No ☐ Purchase ☐ Rent Estimated rental days: MBX Bristle Blaster®: ☐ Yes ☐ No Extra Bristle Blaster belts: ☐ Yes ☐ No Quantity: Testex Press-O-Film® Surface Profile Gage: ☐ Yes ☐ No NRI Applicator ToolBox: ☐ Yes ☐ No Resinator (resin saturation machine): ☐ Yes ☐ No ResBoxes: ☐ Yes ☐ No Size: ☐ 6” ☐ 12” Quanitity: Fire proofing: ☐ Yes ☐ No

Signature: Date:

Send completed form to [email protected] Neptune Research, the Manufacturer of Syntho-Glass®XT (XT), Viper-SkinTM (VS), Thermo-WrapTM (THW), Thermo-WrapTM Inspectable (THWI), and Thermo- WrapTMCF (THWCF) will replace at no charge to the purchaser any product proved to be defective. Responsibility of the Manufacturer and the Distributor is limited to replacement of the product only. Neither the Manufacturer nor the Distributor shall be liable for consequential or incidental damage or loss of any kind as they do not have any control over the conditions under which these products may be used or over the methods of application. Users should test the product for their particular need and suitability. Users should consult with the Manufacturer or the Distributor for all proposed repairs using the XT, VS, THW and/or THWCF Systems. Written procedures for specific repairs are available upon request from the Manufacturer or Distributor. All proposed repairs to Pipeline Systems using the XT, VS, THW and/or THWCF Systems must be installed or supervised by Certified Technicians.

of 2 Form Number: 1005 Revision: 7 Release Date: 09.25.14