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ROFESSIONAL VISUAL CYLINDER INSPECTION EVALUATION FORM

ROFESSIONAL
CUBA c

1NSPECTORS Inspectors must follow PSI - PCI 18 Step Protocol YLINDER

NSPECTORS

Cylinder owner's name Date

Address
City

Stale Zip Code/Postal Code Phone No.

MFG Service SCUBA SCBA Paintball Other Gas Type: Air Nitrox Oxygen Other

Serial No. First hydro date Most recent hydro

Color Working pressure Material: Steel Aluminum F RP Conlposite

Special Permit/Exemption # or Specification Accessories

EXTERNAL
Hammer tone test (steel cylinders only) Bell like tone. Yes No

Evidence of Heat Damage: Yes No Re-painting: Yes No Odor: Yes No Bow: Yes No
Bulges: Yes No a Line corrosion around boot or other accessories. Yes No
Description of exterior surface

Location and estimated depth of pitting

Determination: Accept Reject

INTERNAL
Amount and composition of contents

Description of internal surface

Location and estimated depth of any pitting

Determination: Accept Rerct Condemn

CYLINDER THREADS

011(
Description
Crack assessment

Determination: Accept
 EDDY CURRENT
(6351 T-6 Aluminum Alloy Cylinders Only)
Eddy Current Test Not Applicable to this Cylinder

Instrument manufacturer Model Serial# Probe part or Serial #

Test ring specification RIN# Tester nanle

Determination: Accept:

VALVE & PRD INSPECTION

Service needed: Yes No Burst disc replaced: Yes No O-ring replaced: Dip Tube Replaced. Yes NO
Thread Condition

FINAL DETERMINATION
Accept: Sticker affixed.
Yes a Date With notation
Reject: Clean.
Discarded.
Tumble:
Condemn: Returned to owner:

I cenify that this inspection was done in accordance with prescribed guidelines per USDOT, CGA, OSHA and PSI-PCI standards

Inspector name (Print) PSI-PCI VCI Inspector Number

Inspector signature

Professional Scuba Inspectors, Inc. - Professional Cylinder Inspectors, Inc. 0 2004 (Revised 2021)

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