Visual Inspection Release Form
To Our Valued Customer,
To ensure the safety of all who may come in contact with SCUBA and SCBA and other high pressure cylinders; we fill, handle and use only those cylinders which have a current hydrostatic test mark (5 or 3 years) and have a valid, recognized visual inspection sticker (one year or less). We can arrange these services if your cylinder does not currently comply. We conduct the most precise, technically detailed and Federally compliant visual inspection of high pressure cylinders in the industry today. We use the respected and recognized PSI-PCI, Inc. 18 Step Protocol and insist on accurate assessment of your cylinder to these high standards for both your safety and ours. When a cylinder fails our comprehensive evaluation, you may be certain that a significant potential danger has been identified. We will show you both the problem and the documents that guided our decision.
Our cylinder inspector is formally trained and is certified to perform the vital visual cylinder inspection safety inspection. He/she cannot knowingly allow a cylinder having damage exceeding the allowable limits to remain in service. Therefore, you are hereby informed that should your cylinder fail our formal and documented visual safety inspection, it will be condemned. After required codes and threads have been obliterated, as a conspicuous disabling measure, the cylinder and valve will be returned to you.
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To Visual Cylinder Inspector:
I, ________________________________________________________, owner (or authorized representative) of high pressure cylinder, serial number _______________, have requested your visual inspection and/or hydro test service. I understand that these vital safety examinations are needed at prescribed intervals to ensure the cylinder is safe for filling and continued service. I have been informed that various damaging factors, such as those described in the book Inspecting Cylinders (5th Edition), by William L. (Bill) High and Mark A. Gresham, may cause my cylinder to fail either assessment.
I agree, as a condition of having either service performed on my cylinder, that the cylinder may be conspicuously disabled if it does not meet the accepted standards of quality and I receive a written report which identifies the reason for failure. Also, I will have the disabled cylinder and all components returned to me.
Customer Signature__________________________________________Date__________
