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INSPECTION REPORT FOR GROUTING

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Project/No. Area/Unit Location

: : :

Report No. Date Subcon. Name

: : :

Description Type of grout Elevation

: : :

Ref. DWG. No. Pouring date & time Quantity

: : :

Inspection result No. 1 2 3 4 5 6 Surface Condition Grout material check From work Pouting Curing Finishing Check Items Accept Reject Remarks

Note :

Refer # Markup location attached Main Contractor STR. Sup. QA/QC Sup.

COMPLETED BY COMPANY SIGNATURE NAME DATE

Sub Contractor

Owner Representative

FM-123

INSPECTION REPORT FOR GROUTING


PAGE ____ OF ____

Project/No. Area/Unit Location

: : :

Report No. Date Con. Name

: : :

Description Type of grout Elevation

: : :

Ref. DWG. No. Pouring date & time Quantity

: : :

Inspection result No. 1 2 3 4 5 6 Surface Condition Grout material check From work Pouting Curing Finishing Check Items Accept Reject Remarks

Note :

For TWPC Sign Name : Date : Sign Name : Date :

For EIL