1. DATE
WELDING EXAMINATION RECORD
SECTION I - APPLICATION
2. NAME (Last, First, Middle Initial)
3. PARENT ORGANIZATION
4. UNIT ADDRESS
5. QUALIFICATION GROUP
6. RATING/RATE
7. WELDER IDENTIFICATION
8. EXPIRATION DATE
NUMBER
9. WELDING SCHOOL OR SOURCE OF TRAINING
10. WELDING PROCESS
11. WELDING PROCEDURE
WPS NUMBERS
SPECIFICATIONS
(See Table 3-3 for all parameters.
Use a. - n. for special qualifications)
a. BASE METAL
b. FILLER METAL TYPE
c. FILLER METAL DIAMETER
d. POSITION
e. TORCH SHIELDING GAS TYPE
f. TORCH SHIELDING GAS FLOW
g. ROOT SHIELDING GAS TYPE
h. ROOT SHIELDING GAS FLOW
i. NOZZLE SIZE
j. CURRENT TYPE
k. AMPERAGE
l. ELECTRODE TYPE
m. ELECTRODE DIAMETER
n. NUMBER OF PASSES
12. SIGNATURE OF APPLICANT
13. SIGNATURE OF OBSERVING OFFICIAL.
I certify the weld specimen was completed
by the applicant using the above procedure.
SECTION II - EXAMINATION RESULTS
TEST SPECIMEN
RETEST SPECIMEN
WPS
NUMBERS
14. VISUAL
15. RADIOGRAPHIC
16. BEND
17. METALLOGRAPHIC
14. VISUAL
15. RADIOGRAPHIC
16. BEND
17. METALLOGRAPHIC
18. REMARKS
19. TO OBTAIN REQUALIFICATION OPERATOR MUST:
RESUBMIT EXAMINATION
ATTEND AUTHORIZED WELDING TRAINING SCHOOL
a. SIGNATURE
20. TESTING OFFICIAL
QUALIFIED
NOT QUALIFIED
b. ORGANIZATION AND ADDRESS
c. QUALIFICATION GROUP
d. LEVEL (AF only)
21a. SIGNATURE OF CERTIFYING OFFICIAL
b. DATE CERTIFIED
DD FORM 2757, JUN 1997
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