Doc.

Code :
Rev. No. :
Eff. No. :
Construction Activity for which inspection is requested:
Testing Needed Survey Needed
Yes No Yes No
Result of Inspection:
Inspected and Requested by SCIC QA/QC:
Submission Approved by SCIC MANAGER:
Result of Inspection by CIPC:
Inspected by CIPC : Request to proceed is:
Date
Time
Signature
Time
Title
SCIC QA/QC REMARKS:
SCIC SURVEY REMARKS:
Date
Date Prepared:
Page No. : 1 of 1 CIPC SCIC
QC INSPECTION REQUEST/REPORT FORM
QCIRF Number:
Description
Contract Number: CORON POWER STATION Project Name
Name
Item No. Remarks Location Date Time
Signature
Name Lydio R. Raon
Title SCIC-Project Manager
CIPC-Project Manager Title
Date
Time
Stephen C. Inglis
Disapproved
Signature
Time
Title
Date
Name
Signature
Name
Approved
Jocel B. Benosa
CIPC- Works Engineer