Service Questionnaire Forms

For a cost estimate and additional information regarding your project, please provide the following information by either completing the downloadable PDF documents and emailing to This email address is being protected from spambots. You need JavaScript enabled to view it. or by filling out the online forms below.

Pipeline Coating and Rehabilitation: Information and Service Questionnaire:

Primary Contact:*

MrsMrMs    

Email*

Office Number:*

Position - Title:

Mobile Number:

Client or Company Name:

Classification:*

Municipality

Public / Private Utility

Power Generation

Energy (Oil and Gas)

Mining

Industry

Project Start:

Project End:

Project or Facility Location:*

AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

Pipeline Coating Objective:

Structural Reinforcement

Abrasion Resistance

Repair Leaks / Breaks

Resolve Quality and Flow

Corrosion Prevention

Chemical Resistance

Other

Will the system need to be bypassed:

- Select Value -NoYes

Pipeline Material:

Pipeline Length:

Pipeline ⌀

Age of Insitu Pipe:

Original Wall Thickness:

Current Wall Thickness:

Effluent Type:

Effluent Temperature:

Flow - GPM:

Operating Pressure:

Design Pressure:

Vacuum:

Pipeline Condition:

- Select Value -Partially DeterioratedFully DeterioratedNew Piping

Load-Bearing

- Select Value -HighwayRailroadAirportOthers

Type of Fill:

- Select Value -ClaySandGravelStoneOthers

Water Table:

Soil Compensation: %

Soil Density:

Distance - Spray-Rig to Access:

Type of Access:

Distance Between Access:

Pipe Design Summary: Bends, Joints, Tees, Tapers, Diameter Inconsistencies and Flanges:

Known Defects: Cracks, Joint Separation, Holes, Infiltration, Erosion and Corrosion:

Chemical Composition: Hydrocarbons, pH and % Concentration:

Site Logistics: Compressed Air / Electrical supply available, if yes - provide specifications:

Problem Description, Detailed Explanation: (Additional Concerns)

File Upload: Try to provide drawings, access areas and site photos

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Pipeline Inspection: Information and Service Questionnaire:

Company Name*

Type of Inspection:

MFL

Geometry

Combo Tool

IMU

Contact Name:*

MrsMrMs    

Job Title*

Phone Number*

Facsimile Number

Contact Email*

Field Contact Name:*

MrsMrMs    

Job Title*

Phone Number*

Mobile Phone*

Field Contact Email*

24 Hour Emergency Contact Information:

MrsMrMs    

Job Title*

Phone Number*

Mobile Phone*

24 Hour Emergency Address:

AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

Pipeline Information

Pipeline Liner Present:*

Yes

No

Liner Material and Grade:

Host Pipe Details:*

Section Length (Specify miles/km)*

Outside Diameter (Specify in/cm)*

Test Pressure*

Liner Wall Thickness*

Onshore / Offshore*

Wall Thickness or Schedule#*

Operating Pressure*

Host Pipe Material and Grade*

Fittings Present y/n*

Flange Rating*

Field Bends:

Pipe OD

Degree Bend

Additional Pipeline Information:*

Age of Pipeline*

Operational (y/n)*

Internal Scaling / Other Deposits*

Internal Coating*

Depth of Pipeline*

Joint Connection*

Pipeline Location

Location of Line - From:

Starting Location and Physiography

Location of Line - To:

Ending Location and Physiography

Launch Site Type:

Onshore

Offshore

Launch Site:

ILI Tool Launch Site Location Description

Launch Site Address or GPS Coordinates:

ILI Tool Launch Address or GPS Coordinates

ILI Tool Launch Address or GPS Coordinates

Launch Site City/State/Country

AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

ILI Tool Launch Site City, State/Province, Country

Receiver Site Type:

Onshore

Offshore

Receiver Site:

ILI Tool Receiver Site Location Description

Receiver Site Address or GPS Coordinates:

ILI Tool Receiver Address or GPS Coordinates

Receiver Site City/State/Country

AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

ILI Tool Receiver Site City, State/Province, Country

Maps or Drawings:

Expected Pipeline Features

Expected Pipeline Features

General Corrosion

Mill Defects Pitting

Dents

SCC

HIC

Mechanical Damage

Circumferential Grooving

Axial Grooving

Pipeline Product

Pipeline Product

Crude OilAnhydrous AmmoniaDieselEthyleneGasolineJet FuelLPG - Ethanel/PropaneNatural GasNGL - Natural Gas LiquidsNitrogenWater - FreshWater - SaltOther

Product During Inspection

Crude OilAnhydrous AmmoniaDieselEthyleneGasolineJet FuelLPG - Ethanel/PropaneNatural GasNGL - Natural Gas LiquidsNitrogenWater - FreshWater - SaltOther

Product State:

Gas

Liquid

Gas and Liquid

Temperature:

Temperature Units:

ºC

ºF

Stations:

Yes

No

Interruptions in Flow?

Pressure:

Bars

Kpa

psi

Expected Velocity:

kph

mph

Pipeline Product Chemistry

Paraffin %

H2S %

Iron Sulfide:

Yes

No

Iron Oxide:

Yes

No

NORMS:

Yes

No

Are there procedures to decontaminate and dispose of radioactive waste?

Yes

No

Pipeline History

Inspection History:

Repair History:

Pipeline Connections and Fittings

Are there any < 3D bends (bends with less than 3 diameters of straight pipe between the bends?

Yes

No

Unknown

Bend Details:

Are there any heavy wall bends?

Yes

No

Unknown

Heavy Wall Bend Details:

Are there any mitre bends?

Yes

No

Unknown

Mitre Bend Details:

What is the minimum bend radius in the line?

Are there any < 2D bend (tees with less than 2 diameters of straight pipe between them or a bend)?

Yes

No

Unknown

Tee Details:

Are there any heavy wall tees?

Yes

No

Unknown

Heavy Wall Tee Details:

Are there any full bore tees barred?

Yes

No

Unknown

Full Bore Tee Barred Details:

Are there any check valves in the line?

Yes

No

Unknown

Can the check valves be pinned open?

Yes

No

Unknown

Check Valves Pinned Open Details:

Are there any valves with restrictive bores?

Yes

No

Unknown

Valves with Restrictive Bores Details:

Are there any restricted bores in any block valve?

Yes

No

Unknown

Restricted Bores in Block Valves Details:

Is there any other feature in the pipeline which is not discussed above that could affect the performance of an ILI tool in the pipeline and which PipeGuard™ should be made aware of?

Yes

No

Unknown

Other Feature Disclosure Details:

Inspection Logistics

Is there equipment available to launch and receive the ILI tool?

Yes

No

What equipment will be available to launch and receive the the ILI tool?

Pull In

Pull Out

Push In

Is there equipment available to clean the ILI tool at the receiver?

Yes

No

What equipment will be available to clean the ILI tool at the receiver?

Is there any site specific or specialized training required?

Yes

No

Specialized Training Required:

Desired Start Date:

Trap Information

Total Length to Closure (A):

Launcher

Receiver

Length of Nominal Pipe (B):

Launcher

Receiver

Diameter of Nominal Pipe:

Launcher

Receiver

Length of Oversize Pipe:

Launcher

Receiver

Inside Diameter of Closure:

Launcher

Receiver

Location of Kicker Bypass Line (D):

Launcher

Receiver

Working Space (L x W):

Launcher

Receiver

Type of Reducer:

Launcher

Receiver

Type of Reducer:

Launcher

Receiver

Height (ground to bottom of closure):

Launcher

Receiver

Trap Angle from Horizontal (if not horizontal):

Launcher

Receiver

Launcher - Hoist Available at Trap?

Yes

No

Receiver: Hoist available at trap?

Yes

No

Launcher - Pressure Equalization?

Yes

No

Receiver - Pressure Equalization?

Yes

No

Report Parameters

Report Units

English

Metric

Pressure Criteria

ASME B3IGModified ASME B3IGRSTRING

Grouping Algorithm

6X Wall (cir), 1" (axial)1" Between PitsLength of Shorter Pit6X Wall (cir)6X Wall (cir), 3X Wall (axial)

Evaluation Pressure:

MOP

MAOP

Final Report Media

Cloud

USB Stick

Number of USB Stick Copies Requested:

DVD

Number of DVD Copies Requested:

Print

Number of Print Copies Requested:

Report Delivery Address:

AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

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