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					Chevron Corporation                                                                           ICM-DS-5139
                                              DATA SHEET FOR
                 INSTALLATION, INSPECTION, TESTING, AND COMMISSIONING OF INSTRUMENTATION



 Table 1:     Instrument Discrepancy List

                                                             Scheduled      Actual
                Associated
   Tag #                         Plant Area     Defect       Completion   Completion       Remarks
                Equipment
                                                               Date          Date




June 2007                                                                                      Page 1 of 3
Chevron Corporation                                                                                                  ICM-DS-5139
                                                DATA SHEET FOR
                   INSTALLATION, INSPECTION, TESTING, AND COMMISSIONING OF INSTRUMENTATION

  Table 1:        Calibration Documentation Sheet

   PHYSICAL LOOP COMPONENT CHECKOUT                INSTRUMENT CALIBRATION (for bench calibration or field calibration check)

    LOOP              TAG       CHECKOUT
  COMPONENT           NO.     COMPLETE? Y/N                                                               SWITCH     SWITCH
                                                                      0%   25%    50%    100%    RANGE    SETPOINT   ACTIVATED
                              WIRING   TUBING

                                                Process Input
  Transmitter
                                                Transmitter Output

  Field End                                     Field Device Input
  Device
                                                Field Device Output

                                                Controller Input
  Controller
                                                Controller Output

                                                Input
  Other _______
                                                Output

                                                Input
  Other _______
                                                Output

  Switch

  Switch

  Loop Check Methods and Procedures Used (from Appendix III) _________________________________

  Calibration Approved:     Yes   No              Certification: Company_________________________ Date___________________




June 2007                                                                                                             Page 2 of 3
Chevron Corporation                                                                                                   ICM-DS-5139
                                                      DATA SHEET FOR
                         INSTALLATION, INSPECTION, TESTING, AND COMMISSIONING OF INSTRUMENTATION

  Table 2:           Loop Check Documentation Sheet

                                               PROCESS SIGNAL INPUT                                          ALARM SETTINGS
  Loop Device
  Response (in
                                  0%               25%                  50%                   100%
  engineering                                                                                                           ALARM?
  units)                                                                                                   SETPOINT
                                                                                                                          Y/N
                            EXP        ACT   EXP         ACT      EXP         ACT       EXP          ACT

  Controller Output
  (Controller in auto)

  Indication

  Recorder/Trend

  Alarm 1

  Alarm 2

  Alarm 3

  Alarm 4



  Controller Output                     0                25                   50                     100
  (Controller in Man)

  Field Device
  Response

  Loop Check Methods and Procedures Used (from Appendix):_____________________________________________________

  Loop Folder Complete and Approved: Yes    No      Certification: Contractor_________________________ Date__________________

  Loop Check Approved:        Yes     No            Certification: Company__________________________ Date__________________




June 2007                                                                                                              Page 3 of 3

				
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