Renewal Verification Form

The following is for Local 104 members in good standing. If you are not a Local 104 member, you are not eligible to proceed.

Certifications in accordance with AWS QC7 Supplement C (AWS D9.1) require maintenance every 12 months. Certifications in accordance with AWS QC7 Supplement G or F (All others) require maintenance every 6 months.

Welder's Name

First Middle Initial Last

Welder's IA No.

Enter the date you most recently used the process or processes you would like to maintain.

SMAW

FCAW

GTAW

GMAW

SAW

Solder

Brazing

Laser

Verification By:

Employer or Employer Representative

CWI/Test Supervisor

Local 104 Member

Name of Certifier

First Last

Title or CWI No. of Certifier

Company of Certifier

ATF of Certifier

Smart IA number of Certifier

Phone of Certifier

Date

Signature