Fillable APPENDIX A - GAS PIPING PRESSURE AND LEAKAGE (Central Hudson)

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APPENDIX A - GAS PIPING PRESSURE AND LEAKAGE (Central Hudson)

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www.CentralHudson.com · 284 South Avenue, Poughkeepsie, NY 12601
APPENDIX A - GAS PIPING
PRESSURE AND LEAKAGE TEST
To: Service Supervisor / Project Director
10-digit Account No: Job #:
Example: J1-23456
I certify that I have tested the gas piping system at
Name Street Address
, the results of which are tabulated below.
City/town/zipcode of gas service installation
Diameter
Length (feet/inches)
Pipe Installed
inches
(feet/inches)
Pipe Installed
inches
(feet/inches)
*Test duration is required to be 60 minutes at minimum.
I further certify that the piping described above is free of any leaks, in accordance with Central
Hudson's "Specifications and Requirements for Gas Installations", and adequate to serve gas to
the appliances installed at the above-mentioned location.
Company Name: Phone Number:
Print Name Signature Date
Please fax completed form to the closest district to your installation.
Residential Gas Conversion (Company Wide): 845-563-4503 /
gaswork@cenhud.com
Ca
tskill District: 518-943-7099
Kingston District: 845-338-5075
Poughkeepsie District: 845-486-5688
Fishkill District: 845-897-6115
Newburgh District: 845-563-4503
Notes:
1) A minimum of two (2) readings shall be taken not less than 30 minutes apart. Test pressures shall
be in accordance with the Fuel Gas Code of New York State. The test pressure to be used shall
be no less than 1-1/2 times the proposed maximum working pressure, but no less than 3 psig
(20 kPa gauge), irrespective of design pressure.
2) Submitting this form does not constitute a meter order.
3) The results of this test shall be deemed valid for a period of two (2) years from the date of the
test barring any changes to the piping system.
4) In activating the service, an initial inspection by Central Hudson personnel will be done at no
charge. If the piping system fails to meet our requirements, a fee may be applied for each
subsequent re-inspection conducted, with payment to be made prior to the re-inspection.
Test Date
Time
Gauge Pressure
Read By
Start of Test
psi
1
st
Reading*
psi
2
nd
Reading*
psi
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APPENDIX A - GAS PIPING PRESSURE AND LEAKAGE (Central Hudson)

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Completed 9 June 2021

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