Inquiry Form

PIPE FREEZING / HOT TAPPING / LINE STOPPING INQUIRY FORM

Company Name

Customer Name

Rep

Address

Job Name

Date

Region

Customer Scope of Work

Priority of work

Line Contents

Pipe Schedule/Class/DR Rating

Pipe Rating

Wall Thickness (if applicable)

Safety Training Requried

Material Type/Grade

Operating Pressure

Operating Temperature

Pipe Freezing

How many freezes are needed

Simultaneous

Pipe freeze hold time

Clearance around pipe?

Close to a header with flow?

Glycol present?

Distance from freeze plug to scope of work?

Nitrogen bottles within 25ft. of work area?

Nitrogen bottle distance?

What are the freeze sizes?

Mobilizations to complete freeze(s)

Length of straight-run pipe for freeze jacket

Is there a controlled drain down method?

Distance to header with flow?

% of Glycol present

Line Stop / Hot Tap

Application

Location

Style

Line Stop Style

Branch Size

Fitting Model

Line Stop

Operating Flow-rate?

Type (Check all that apply)

Design Code?

Flange Type

Customer Signature

Additional Notes

CryoStop Rep