PROJECT

: :

DUNG QUAT REFINERY ( DQR ) PROJECT VIETNAM OIL AND GAS CORPORATION (PETROVIETNAM )

QUALITY CONTROL FORM

QCF 113

CLIENT

INSERT REBAR INSPECTION REPORT ITEM: DRAWING No. UNIT / AREA COMPOUND TYPE: ADHESIVE CHEMICAL COMPOUND Methods of Preparation : By Drilling and cleaning. INSPECTIONS S/ N 1. 2. 3 4 DESCRIPTION Inspection of Depth of Hole Inspection of Dia. Of Hole Inspection of Hole Cleaning Inspection of Rebar : - Size - Length - Anchor Length : 5 Final Inspection after filling. ACC NOT ACC REMARKS Brand _____________________ Name________________ ___________________________________________________________ _______________________________ _______________________________ REV. ______ SH__ OF __

REMARKS

TEST RESULT: ACCEPTED NOT ACCEPTED SUBCONTRACTOR NAME SIGNATURE DATE CONTRACTOR CLIENT

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