Link-Seal® Modular Seal Field Analysis Summary Sheet
	Distributor Information Date: Link-Seal Distributor: Requested By: Contractor Name: Telephone: e-mail: Job Name: Project Information Link-Seal® Model: LS-200 LS-275 LS-300 LS-315 LS-325 LS-340 LS-360 LS-400 LS-410 LS-425 LS-475 LS-500 LS-525 LS-575 LS-600 LS-650 Number of Links: Measured Pipe Circumference: Type of Pipe: Is Pipe Coated? YesNo Type of Hole: Model WS Sleeve Model CS Sleeve Model CC Disks Steel Sleeve PVC Sleeve Cored Hole Other Hole Diameter: OR WS/CS/CC Model: Is Pipe Centered? YesNo Is Pipe Supported? YesNo	Please include annular space measurements (in inches) at locations shown below. (Annular space is the distance between the pipe O.D. and penetration I.D.) Position #LS12 Position #LS11 Position #LS02 Position #LS09 Position #LS03 Position #LS08 Position #LS05 Position #LS06 Comments/Observations: Location of Problem: