ITP-Pile Caps (Be Tru) (Viaduct) Rev.e - sh01

K Hoch Kim Tra V Nghim Thu Thi Cng i Cc - C
D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Gi Thu -2: Xy Dng (on Trn Cao v Depot)
ITP s. : HCMC-260-VDGN-CVS-PLN-00002-E Hng Mc Thi cng S: S. 5.2.1.xx Thi cng i cc cu cn STT I 1 Cng Vic Thi Cng/ Hot ng S : E M T Hng Mc Thi Cng:
Ch u T: i Din Ch u T: Nh Thu:
Ngy lp : 7/5/2013 Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tn
K Hoch Kim Tra v Nghim Thu
Cng tc chun b
Cc ti liu chun b : Ngy Thng nm 2013 Kim tra B tng ti : Ngy Thng nm 2013 Giao nhn thp/cng tc ly mu thp Ngy Thng nm 2013 Tp kt Thit B thi cng i cc : Ngy Thng nm 2013 < Trnh t cng vic> Kim tra khung vy ca h mng (nu yu cu) Cao , ta h o b tng / th nghim st b tng/ o nhit b tng lt Phiu b tng lt Cao & ta b tng lt Lp t ct thp Ta v cao vn khun/ Tim dc, tim ngang Cng tc chun b b tng b tng / th nghim st b tng/ o nhit b tng i cc
4 II 5
10
11
12
13
14
Phiu b tng i cc Nghim thu kt cu hon thnh (i cc) (Kim tra tim dc, tim ngang, ta , cao , kch thc..) Bin bn kim tra p tr kt cu <Th nghim>
15
16
17
Bin bn kim tra Th nghim thp
18
Th nghim b tng lt
19
Th nghim b tng
Kim Tra bi Thi Cng Qun L Cht Lng
Xc Nhn
Son Tho bi
Tn v Chc v
K Hoch Kim Tra V Nghim Thu Thi Cng i Cc - C

ITP s. : HCMC-260-VDGN-CVS-PLN-00002-E Hng Mc Thi cng S: S. 5.2.1.xx Thi cng i cc cu cn STT Cng Vic Thi Cng/ Hot ng Tn v Chc v S : E M T Hng Mc Thi Cng:
Ngy lp : 7/5/2013 Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tn
Ch K Ngy
Ghi Ch
H - Thc Hin W - Chng kin TBA - S thng bo sau
SCC - i din tng thu SCC NJPT - i din ch u t
a V Nghim Thu Thi Cng i Cc - Cu Cn

Ban Qun L ng St Th Lin Danh NJPT i din tng thu SCC
h i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng (Khu vc cu cn)

Tiu Chun/Quy Chun K Thut lin quan Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng n v chng nhn S Bin Bn
SCC
Ghi nhn S 5.2.1.xx-01 Ghi nhn S 5.2.1.xx-02 Cng tc xy dng S 5.2.1.xx-01 Cng tc xy dng S 5.2.1.xx-02
SCC
NJPT
NJPT
Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ JIS A 1101 hoc AASHTO Phng php th nghim T119 Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ TCVN 4453 : 1995 Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ TCVN 4453 : 1995 Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ JIS A 1101 hoc AASHTO Phng php th nghim T119 Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng
SCC
Ghi nhn S 5.2.1.xx-03 Ghi nhn S 5.2.1.xx-04
SCC
SCC
Ghi nhn S 5.2.1.xx-05
SCC
Ghi nhn S 5.2.1.xx-06 Ghi nhn S 5.2.1.xx-07 Cng tc xy dng S 5.2.1.xx-03 Cng tc xy dng S 5.2.1.xx-04 Ghi nhn S 5.2.1.xx-08
NJPT
NJPT
NJPT
SCC
SCC
SCC
Ghi nhn S 5.2.1.xx-10 Cng tc xy dng S 5.2.1.xx-05 Cng tc xy dng S 5.2.1.xx-06
NJPT
NJPT
Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/JIS G 3112 Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ Phng php JIS A 1108 hay Phng php th nghim AASHTO T22 Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ Phng php JIS A 1108 hay Phng php th nghim AASHTO T22 Kim Tra bi Qun L Cht Lng
n v thc hin th nghim c duyt (TBA) n v thc hin th nghim c duyt (TBA)
Cng tc xy dng S 5.2.1.xx-07
n v thc hin th nghim c duyt (TBA)
Ph Duyt bi
a V Nghim Thu Thi Cng i Cc - Cu Cn

h i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng (Khu vc cu cn)

Tiu Chun/Quy Chun K Thut lin quan n v chng nhn S Bin Bn
Inspection and Testing Plan for Pile cap - Viaduct

Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) Contract Package-2: Civil (Elevated and Depot)
ITP No. : HCMC-260-VDGN-CVS-PLN-00002-E Rev. No : E No. of Construction Job No. 5.2.1.xx Cast-in-situ Pile cap at Viaduct Description of Construction Job :
Employer : Employer's Representative : Contractor :
Management Authority for Urban Railways NJPT Association General Contractor, SCC s Representative
Issued Date : 5-Jul-13 Complete Cast-in-situ Pile cap including Excavation, Lean Concrete or Sealing Concrete, Supply and installation of Reinforcement, Form Work, Concrete placing and curing (Viaduc
Inspection and Testing Plan

No. Construction Job / Activity <Preparation works> 1 Preparation Documents H W Every Pile cap Construction Drawings Method Statement Related Approved Documents Method Statement Delivery Slip Visual Employer's requirement Work Spec/OCS SCC NJPT Frequency of inspection/test Related Documents Method of inspection/test Compliance criteria Specification / Related Code & Standards
Checking of Ready Mix Concrete
Every Pile cap Every Delivery and each bottom Every set up of Equipment
Visual
Employer's requirement
Work Spec/OCS
Delivery of Reinforcing Steel Bar/Sampling for testing
Mill Sheet
Work Spec/OCS
Mobilization Equipment of Pile cap <Sequence of works>
Method Statement
Visual & Measurement
Work Spec/OCS
Checking cofferdam of foundation hole (if required)
Every Pile cap
Construction drawing, method statement Construction Drawings
Materials type ,Joint, dimensions, stabilizing Not higher than design elevation 125 25 mm, Not more than 35 Employer's requirement
Work spec/OCS
Foundation Hole Elevation, Coordinate Concrete Placing/ Slump Test / Temperature Measurement of lean concrete Concrete Placing Record of lean concrete
Every Pile cap
Visual & Measurement Slump Test, Checking Temperature Time, Volume
Work Spec/OCS Work Spec/OCS/JIS A 1101 or AASHTO Test Method T119 Work Spec/OCS Work Spec/OCS/ TCVN 4453 : 1995 Work Spec/OCS Work Spec/OCS/ TCVN 4453 : 1995 Work Spec/OCS Work Spec/OCS/JIS A 1101 or AASHTO Test Method T119 Work Spec/OCS
Every Truck
Construction Specifications
Every Pile cap
Delivery Sheet
Lean Concrete Ele.& Coordinate
Every Pile cap
Construction Drawings
Ele. 20mm
10
Arrangement of Steel Bar Formwork Coordinate & Elevation/ Centerline on longitudinal, transversal direction Preparation work for Concrete Placing Concrete Placing/ Slump Test / Temperature Measurement of Pile cap Concrete Placing Record of Pile cap Structure completed (Pile Cap) (Checking centerline on longitudinal, transversal direction, Coordinate, Elevation, Dimension..) Backfilling Works of Structure
Every Pile cap
Size, Spacing, Splicing +25 mm and -12 mm Coordinate 5 mm Ele. 10 mm Employer's requirement 100 25 mm, Not more than 35 Employer's requirement Construction Joint, Visual shape & Surface Checking k 90%
11
Every Pile cap
12
Every Pile cap
Method Statement
Visual Slump Test, Checking Temperature Time, Volume
13
Every Truck
14
Every Pile cap
Method Statement
15
Every Pile cap
Work Spec/OCS
16
Every Pile cap
Method Statement
Work Spec/OCS
Inspection and Testing Plan for Pile cap - Viaduct

Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) Contract Package-2: Civil (Elevated and Depot)
ITP No. : HCMC-260-VDGN-CVS-PLN-00002-E Rev. No : E No. of Construction Job No. 5.2.1.xx Cast-in-situ Pile cap at Viaduct Description of Construction Job :
Employer : Employer's Representative : Contractor :
Management Authority for Urban Railways NJPT Association General Contractor, SCC s Representative
Issued Date : 5-Jul-13 Complete Cast-in-situ Pile cap including Excavation, Lean Concrete or Sealing Concrete, Supply and installation of Reinforcement, Form Work, Concrete placing and curing (Viaduc

< Testing> 17 Reinforcing steel bar testing H H Each Size as OCS Construction Specifications Laboratory test Grade of Reinforcing Steel Bar refer to design Drawing Work Spec/OCS/ JIS G 3112 Work Spec/OCS/ JIS A 1108 or AASHTO Test Method T22 Work Spec/OCS/ JIS A 1108 or AASHTO Test Method T22
18
Concrete / Compressive Strength of lean concrete
every 30m3 After 28 days
Laboratory test
15Mpa
19
Concrete / Compressive Strength
every 30m3 After 28 days
Laboratory test
35Mpa
Clasification
Prepared by
Checked by Construction Quality
Approved by
Name and Position
Signature
Date
LEGEND:
H - Hold Point W - Witness Point TBA - To be announced
SCC - General Contractor, SCC s Representative NJPT - Employer's Representative
d Testing Plan for Pile cap - Viaduct

Management Authority for Urban Railways General Contractor, SCC s Representative
n-situ Pile cap including Excavation, Lean Concrete or Sealing Concrete, Supply and installation of Reinforcement, Form Work, Concrete placing and curing (Viaduct Location)

Certifying Party Record No
SCC
Record No. 5.2.1.xx-01 Record No. 5.2.1.xx-02 Construction Job No. 5.2.1.xx-01 Construction Job No. 5.2.1.xx-02
SCC
NJPT
NJPT
SCC
Record No. 5.2.1.xx-03 Record No. 5.2.1.xx-04 Record No. 5.2.1.xx-05 Record No. 5.2.1.xx-06 Record No. 5.2.1.xx-07 Construction Job No. 5.2.1.xx-03 Construction Job No. 5.2.1.xx-04 Record No. 5.2.1.xx-08 Record No. 5.2.1.xx-09 Record No. 5.2.1.xx-10 Construction Job No. 5.2.1.xx-05 Construction Job No. 5.2.1.xx-06
SCC
SCC
SCC
NJPT
NJPT
NJPT
SCC
SCC
SCC
NJPT
NJPT
d Testing Plan for Pile cap - Viaduct

Management Authority for Urban Railways General Contractor, SCC s Representative
n-situ Pile cap including Excavation, Lean Concrete or Sealing Concrete, Supply and installation of Reinforcement, Form Work, Concrete placing and curing (Viaduct Location)
Testing Laboratory (TBA) Testing Laboratory (TBA)
Construction Job No. 5.2.1.xx-07 Record No. 5.2.1.xx-11
Testing Laboratory (TBA)
Construction Job No. 5.2.1.xx-08
Approved by
K Hoch Kim Tra V Nghim Thu Thi Cng i Cc - Cu Cn

ITP s. : HCMC-260-VDGN-CVS-PLN-00002-E Hng Mc Thi cng S: S. 5.2.1.xx Thi cng i cc cu cn STT Cng Vic Thi Cng/ Hot ng <Cng tc chun b> 1 Cc ti liu chun b H W Mi i cc Bn v thi cng Bin php thi cng Cc h s lin quan Bin php thi cng Phiu giao nhn Quan St Yu cu ca Ch u T Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng SCC S : E M T Hng Mc Thi Cng:
Ngy lp : 7/5/2013 Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng (Khu vc cu cn)

SCC NJPT Tn s thc hin Kim tra/ kim tra H s lin quan Phng php Kim tra/ kim tra Tiu Chun Yu Cu Tiu Chun/Quy Chun K Thut lin quan n v chng nhn
Kim tra B tng ti
Mi i cc Mi ln giao nhn v mi b mng Mi ln tp kt thit b
Quan St
Yu cu ca Ch u T
SCC
Giao nhn thp/cng tc ly mu thp
Chng ch xut xng
Yu cu ca Ch u T
NJPT
Tp kt Thit B thi cng i cc < Trnh t cng vic>
Bin php thi cng
Quan St v o c
Yu cu ca Ch u T
NJPT
Kim tra khung vy ca h mng (nu yu cu)
Mi i cc
Bn v thi cng, bin php thi cng Bn v thi cng
Cao , ta h o
Mi i cc
b tng / th nghim st b tng/ o nhit b tng lt
Mi xe b tng
Tiu Chun Xy Dng
Phiu b tng lt
Mi i cc
Phiu giao nhn
Cao & ta b tng lt
Mi i cc
Bn v thi cng
Tiu chun thi cng/ Loi vt liu, cc lin kt, Cng Tiu Chun K Thut cc kch thc, n nh Thi Cng Tiu chun thi cng/ Khng cao hn cao thit Quan St v o c Cng Tiu Chun K Thut k Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut o st b tng 125 25 mm, Thi Cng/ Kim tra nhit Khng ln hn 35 JIS A 1101 hoc AASHTO Phng php th nghim T119 Tiu chun thi cng/ Thi Gian v Khi Lng b Yu cu ca Ch u T Cng Tiu Chun K Thut tng Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Quan St v o c Cao . 20mm Thi Cng/ TCVN 4453 : 1995 Quan St v o c Quan St v o c Kch Thc, Khong cch, Mi ni +25 mm v-12 mm ta 5mm cao 10mm Yu cu ca Ch u T Cng Tiu Chun K Thut Thi Cng Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ TCVN 4453 : 1995 Cng Tiu Chun K Thut Thi Cng
SCC
SCC
SCC
SCC
NJPT
10
Lp t ct thp
Mi i cc
Bn v thi cng
NJPT
11
Ta v cao vn khun/ Tim dc, tim ngang
Mi i cc
Bn v thi cng
Quan St v o c
NJPT
12
Cng tc chun b b tng
Mi i cc
Bin php thi cng
o c
SCC
K Hoch Kim Tra V Nghim Thu Thi Cng i Cc - Cu Cn

ITP s. : HCMC-260-VDGN-CVS-PLN-00002-E Hng Mc Thi cng S: S. 5.2.1.xx Thi cng i cc cu cn STT Cng Vic Thi Cng/ Hot ng S : E M T Hng Mc Thi Cng:
Ngy lp : 7/5/2013 Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng (Khu vc cu cn)

SCC NJPT Tn s thc hin Kim tra/ kim tra H s lin quan Phng php Kim tra/ kim tra Tiu Chun Yu Cu Tiu Chun/Quy Chun K Thut lin quan Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ JIS A 1101 hoc AASHTO Phng php th nghim T119 Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng n v chng nhn
13
b tng / th nghim st b tng/ o nhit b tng i cc
Mi xe b tng
Tiu Chun Xy Dng
o st b tng Kim tra nhit
100 25 mm, Khng ln hn 35
SCC
14
Phiu b tng i cc
Mi i cc
Bin php thi cng
Thi Gian v Khi Lng b tng
Yu cu ca Ch u T
SCC
15
Nghim thu kt cu hon thnh (i cc) (Kim tra tim dc, tim ngang, ta , cao , kch thc..)
Mi i cc
Bn v thi cng
Quan St v o c
Tiu chun thi cng/ Mi ni thi cng, b mt v Cng Tiu Chun K Thut hnh dng Thi Cng k 90% Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng
NJPT
16
Bin bn kim tra p tr kt cu <Th nghim>
Mi i cc
Bin php thi cng
Quan St v o c
NJPT
17
Bin bn kim tra Th nghim thp
Theo ng knh thp
Tiu Chun Xy Dng
Th Nghim ti phng
Tiu chun thi cng/ Cng thp theo bn v Cng Tiu Chun K Thut thit k Thi Cng/JIS G 3112 Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ Phng php JIS A 1108 hay Phng php th nghim AASHTO T22 Tiu chun thi cng/ Cng Tiu Chun K Thut Thi Cng/ Phng php JIS A 1108 hay Phng php th nghim AASHTO T22
n v thc hin th nghim c duyt (TBA) n v thc hin th nghim c duyt (TBA)
18
Th nghim b tng lt
Mi 30m3 sau 28 ngy
Tiu Chun Xy Dng
Th Nghim ti phng
15Mpa
19
Th nghim b tng
Mi 30m3 sau 28 ngy
Tiu Chun Xy Dng
Th Nghim ti phng
35Mpa
n v thc hin th nghim c duyt (TBA)
Xc Nhn
Son Tho bi
Kim Tra bi Thi Cng Qun L Cht Lng
Ph Duyt bi
Tn v Chc v
Ch K Ngy
Ghi Ch
H - Thc Hin W - Chng kin TBA - S thng bo sau
SCC - i din tng thu SCC NJPT - i din ch u t
Nghim Thu Thi Cng i Cc - Cu Cn

gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng (Khu vc cu cn)
Hoch Kim Tra v Nghim Thu

S Bin Bn
Ghi nhn S 5.2.1.xx-01 Ghi nhn S 5.2.1.xx-02 Cng tc xy dng S 5.2.1.xx-01 Cng tc xy dng S 5.2.1.xx-02
Ghi nhn S 5.2.1.xx-03 Ghi nhn S 5.2.1.xx-04
Ghi nhn S 5.2.1.xx-06 Ghi nhn S 5.2.1.xx-07 Cng tc xy dng S 5.2.1.xx-03 Cng tc xy dng S 5.2.1.xx-04 Ghi nhn S 5.2.1.xx-08
Nghim Thu Thi Cng i Cc - Cu Cn

gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng (Khu vc cu cn)
Hoch Kim Tra v Nghim Thu

S Bin Bn
Ghi nhn S 5.2.1.xx-10 Cng tc xy dng S 5.2.1.xx-05 Cng tc xy dng S 5.2.1.xx-06
Ph Duyt bi
Ho Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot) D n Xy dng Tuyn ng st th s 1 TP. H Ch Minh Tuyn Bn Thnh - Sui Tin Gi thu s 2: Xy dng (on trn cao v Depot) CERTIFICATE FOR ACCEPTANCE OF CONSTRUCTION PARTS BIN BN NGHIM THU CC PHN VIC XY DNG
Form (5a)
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Parts have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant). Consequently in accordance with Decree 48/2010/ND-CP dated 7 May 2010 this Certificate shall be the supporting document for Application of Interim Payment by SumitomoCIENCO6 Consortium. Cn c Ngh nh 15/2013/ND-CP, ngy 6 thng 2 nm 2013, cc phn vic xy dng sau y c thc hin bi nh thu ph ca Lin danh SumitomoCIENCO6 (SCC) v c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). Theo , cn c theo Ngh nh 48/2010/ND-CP ngy 7 thng 5 nm 2010, Bin bn ny s l Ti liu h tr cho Yu cu thanh ton tm bi Lin danh Sumitomo-CIENCO 6.
Object of Acceptance Inspection and Certificate i tng nghim thu No. of Construction Part: S ca Phn vic xy dng Description of Construction Part: M t ca Phn vic xy dng Achievement of Construction Part: Phn vic xy dng hon thnh : No. 5.2.1.xx S 5.2.1.xx Complete all pile caps including Structural Excavation, Form work, Re-bar installation and concrete placing at each pier Hon thnh ton b i cc bao gm o, vn khun, lp t ct thp v b tng ti mi ct Complete Cast-in-situ Pile cap including Excavation, Lean Concrete or Sealing Concrete, Supply and installation of Reinforcement, Form Work, Concrete placing and curing Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng
Participants to Acceptance Inspection Thnh phn tham gia nghim thu Employer's Representative (NJPT) i din Ch u t (NJPT) Sumitomo-CIENCO6 Consortium Lin danh Sumitomo-CIENCO 6
Name of Person in charge Tn ngi ph trch Signature: Ch k: Date of Acceptance Inspection Ngy nghim thu Date:. Ngy:
Name of Person in charge Tn ngi ph trch Signature: Ch k:
Place: . a im:.
Assessment of Completed Construction Part / nh gi cng vic xy dng hon thnh Following have been inspected by parties / Cc ti liu sau c nghim thu bi cc bn: a) Documents as basis for Inspection / Ti liu dng lm cn c nghim thu Base on Contract No.61/H-BQLST Cn c Hp ng s 61/H-BQLST Decision of Approval for Subcontractor : Ref No Date . Quyt nh ph duyt nh thu ph: S .. Ngy Working Drawing Approved and Design changes Approved :Ref No Date . Bn v thi cng c duyt v nhng thay i thit k c chp thun: S ... Ngy . Method Statement for Construction Approved:Ref No Date . Bin php thi cng c duyt: S Ngy .. Inspection and Testing Plan(ITP) Approved: Ref No.. Date. K hoch kim tra v nghim thu (ITP) c duyt: S ... Ngy . Request for Inspections of General Contractor SCC: As Attached Phiu yu cu kim tra ca tng thu SCC : nh km Request for Acceptance for Pile cap of General Contractor SCC: As Attached Phiu yu cu nghim thu cng tc i cc ca tng thu SCC : nh km
Page 13 of 70
Technical standard, norm applied: Quy chun, tiu chun c p dng: - Project Employer's Requirement - General Yu cu chung d n ca Ch u t - Project Outline Construction Specification Tiu chun xy dng chung ca d n - TCVN 4453 : 1995: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance TCVN 4453 : 1995: Kt cu btng v btng ct thp ton khi - Quy phm thi cng v nghim thu - Other standards for Material Testing shown in the Project Outline Construction Specification Cc tiu chun th nghim vt liu khc c th hin trong Tiu chun xy dng chung ca d n b) Quality of Inspected Work / nh gi cht lng cng vic c nghim thu
c) Inspection of Work on site including measurements / Nghim thu thc t ti hin trng bao gm kt qu o kim tra - Test result of material and equipment: As Attached Kt qu kim tra th nghim vt liu v thit b: nh km - Site construction Inspection sheets: As Attached Cc bin bn kim tra hin trng: nh km - Construction diary and other related documents Nht k thi cng v cc ti liu khc lin quan - Internal Acceptance for General Contractor Bin bn nghim thu ni b tng thu d) Comments of Employer's Representative (NJPT) if any / Nhn xt ca i din Ch u t (NJPT) nu c
Conclusion Kt lun
Accepted ng nghim thu Accepted Subject to Rectification of Comments Noted (Note: Punch List is attached) ng nghim thu vi sa cha nh phn Nhn xt (Ghi ch: Danh sch nh km) Not Accepted Khng ng nghim thu
Employer's Representative (NJPT) i din Ch u t (NJPT) Project Manager: (Full Name and Signature) Gim c d n (K, h tn)
Sumitomo-CIENCO6 Consortium Lin danh Sumitomo-CIENCO 6 Project Manager: (Full Name and Signature) Gim c d n (K, h tn)
Douglas Lindsay DUNBAR
Shigeki IHARA
Page 14 of 70
Ho Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot) D n Xy dng Tuyn ng st th s 1 TP. H Ch Minh Tuyn Bn Thnh - Sui Tin Gi thu s 2: Xy dng (on trn cao v Depot) CHECK LIST FOR CERTIFICATE FOR ACCEPTANCE OF CONSTRUCTION PARTS BIN BN KIM TRA H S NGHIM THU CNG VIC XY DNG
Object of Acceptance Inspection and Certificate i tng nghim thu No. of Construction Part: S ca Phn vic xy dng Description of Construction Part: M t ca Phn vic xy dng Achievement of Construction Part: Phn vic xy dng hon thnh : Comply with: Tun theo: CERTIFICATE FOR ACCEPTANCE OF CONSTRUCTION JOBS BIN BN NGHIM THU CC CNG VIC XY DNG Ref. No. S Not required Khng yu cu Not required Khng yu cu Certificate of Job / BB Nghim thu No. 5.2.1.xx-01 Certificate of Job / BB Nghim thu No. 5.2.1.xx-02 Not required Khng yu cu Not required Khng yu cu Not required Khng yu cu Not required Khng yu cu Not required Khng yu cu Certificate of Job / BB Nghim thu No. 5.2.1.xx-03 Certificate of Job / BB Nghim thu No. 5.2.1.xx-04 Not required Khng yu cu Not required Khng yu cu Not required Khng yu cu Signiture Ch k SCC NJPT No. 5.2.1.xx S 5.2.1.xx Complete all pile caps including Structural Excavation, Form work, Re-bar installation and concrete placing at each pier Hon thnh ton b i cc bao gm o, vn khun, lp t ct thp v b tng ti mi ct Complete Cast-in-situ Pile cap including Excavation, Lean Concrete or Sealing Concrete, Supply and installation of Reinforcement, Form Work, Concrete placing and curing Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tng v bo dng
Work Item based on the Contractor's Inspection & Testing Plan Cng vic da trn K hoch Nghim thu & Kim tra ca Nh thu
INSPECTION SHEETS BY THE CONTRACTOR PHIU NGHIM THU BI NH THU Signiture Ch k SCC NJPT
Check Box Kim tra
Ref. No. S Record No. 5.2.1.xx-01 Record No. 5.2.1.xx-02 Certificate of Job / BB Nghim thu No. 5.2.1.xx-01 Certificate of Job / BB Nghim thu No. 5.2.1.xx-02 Record No. 5.2.1.xx-03 Record No. 5.2.1.xx-04 Record No. 5.2.1.xx-05 Record No. 5.2.1.xx-06 Record No. 5.2.1.xx-07 Certificate of Job / BB Nghim thu No. 5.2.1.xx-03 Certificate of Job / BB Nghim thu No. 5.2.1.xx-04 Record No. 5.2.1.xx-08 Record No. 5.2.1.xx-09 Record No. 5.2.1.xx-10
N/A
Preparation Documents Cc ti liu chun b Checking of Ready Mix Concrete Kim tra B tng ti Delivery of Reinforcing Steel Bar/Sampling for testing Giao nhn thp/cng tc ly mu thp Mobilization Equipment of Pile cap Tp kt Thit B thi cng i cc Checking cofferdam of foundation hole(if required) Kim tra khung vy ca h mng (nu yu cu) Foundation Hole Elevation, Coordinate Cao , ta h o Concrete Placing/ Slump Test / Temperature Measurement of lean concrete b tng / th nghim st b tng/ o nhit b tng lt Concrete Placing Record of lean concrete Phiu b tng lt Lean Concrete Ele.& Coordinate Cao & ta b tng lt Arrangement of Steel Bar Lp t ct thp Formwork Coordinate & Elevation/ Centerline on longitudinal, transversal direction Ta v cao vn khun/ Tim dc, tim ngang Preparation work for Concrete Placing Cng tc chun b b tng Concrete Placing/ Slump Test / Temperature Measurement of Pile cap b tng / th nghim st b tng/ o nhit b tng i cc Concrete Placing Record of Pile cap Phiu b tng i cc
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11
12
13
14
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Structure completed (Pile Cap) (Checking centerline on longitudinal, transversal direction, Coordinate, Elevation, Dimension..) Nghim thu kt cu hon thnh (i cc) (Kim tra tim dc, tim ngang, ta , cao , kch thc..) Backfilling Works of Structure Bin bn kim tra p tr kt cu Reinforcing steel bar testing Bin bn kim tra Th nghim thp Concrete / Compressive Strength of lean concrete Th nghim b tng lt Concrete / Compressive Strength Th nghim b tng Internal Acceptance Nghim thu ni b
Certificate of Job / BB Nghim thu No. 5.2.1.xx-05
Certificate of Job / BB Nghim thu No. 5.2.1.xx-05
16
Certificate of Job / BB Nghim thu No. 5.2.1.xx-06 Certificate of Job / BB Nghim thu No. 5.2.1.xx-07 Not required Khng yu cu Certificate of Job / BB Nghim thu No. 5.2.1.xx-08
Certificate of Job / BB Nghim thu No. 5.2.1.xx-06 Certificate of Job / BB Nghim thu No. 5.2.1.xx-07 Record No. 5.2.1.xx-11 Certificate of Job / BB Nghim thu No. 5.2.1.xx-08
17
18
19
20
Employer's Representative (NJPT) i din Ch u t (NJPT) Name of Person in charge:

Tn ngi ph trch
Sumitomo-CIENCO6 Consortium Lin danh Sumitomo-CIENCO 6 Name of Person in charge:

Tn ngi ph trch
Signature: Ch k:
Signature: Ch k:
Date: Ngy:
Date: Ngy:
16 of 70
THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc ------------------------Place (a im):. Date (Thi gian):/../ MINUTES NUMBER/ BIN BN S: . INTERNAL ACCEPTANCE FOR PILE CAP OF VIADUCT NGHIM THU NI B CNG TC I CC CU CN PROJECT: Ho Chi Minh City Urban Railway Construction Project Ben Thanh - Suoi Tien Section (Line 1) CNG TRNH: D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) 1. Object of acceptance: i tng nghim thu: Piles Cap No. .. At Pier Location. Thi cng i cc s . Ti v tr Tr .
Location : Coordinate/Ta X= . V tr xy dng: Y= 2. Acceptance participants/ Thnh phn trc tip nghim thu: a) SCCs Supervision Representative (Sumitomo - Cienco6 Consortium): i din Gim st ca Tng thu SCC (Lin Danh Sumitomo - Cienco6) : - Mr. . - Mr. . b) Sub-Contractor s Representative: i din nh thu ph: - Mr. . - Mr. . 3. Time of Acceptance/ Thi gian nghim thu: From/ T: .. (Date/ ngy . month/ thng ... year/nm ..) To/ n:.. At/ Ti:. Construction Site/ Hin trng 4. Evaluation for implemented work item/ nh gi cng vic c thc hin: a) Related documents used for acceptance/ V cc ti liu lm cn c nghim thu: Decision of Approval for Subcontractor : Ref No Date . Quyt nh ph duyt nh thu ph: S .. Ngy Working Drawing Approved and Design changes Approved :Ref No Date . Bn v thi cng c duyt v nhng thay i thit k c chp thun: S ... Ngy . Method Statement for Construction Approved:Ref No Date . Bin php thi cng c duyt: S Ngy .. Inspection and Testing Plan(ITP) Approved: Ref No.. Date. K hoch kim tra v nghim thu (ITP) c duyt: S ... Ngy . Technical standard, norm applied: Quy chun, tiu chun c p dng: (Date/ ngy . month/ thng ... year/nm ..) : Site Manager/ Ch huy cng trng : Engineer in charge/ K s ph trch trc tip : Supervision Manager / Qun l Gim st : Supervision Engineer / K s Gim st
- Project Employer's Requirement - General Yu cu chung d n ca Ch u t - Project Outline Construction Specification Tiu chun xy dng chung ca d n - TCVN 4453 : 1995: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance TCVN 4453 : 1995: Kt cu btng v btng ct thp ton khi - Quy phm thi cng v nghim thu - Other standards for Material Testing shown in the Project Outline Construction Specification Cc tiu chun th nghim vt liu khc c th hin trong Tiu chun xy dng chung ca d n Test result of material and equipment: Kt qu kim tra th nghim vt liu v thit b: - Test result of material and equipment: As Attached Kt qu kim tra th nghim vt liu v thit b: nh km - Construction diary and other related documents Nht k thi cng v cc ti liu khc lin quan - Site construction Inspection sheets: As Attached Cc bin bn kim tra hin trng: nh km Quantity Complete/ Khi lng thi cng: - Piles Cap No. .. Type . i cc s . Loi . b) Construction quality (Comparison with design, standard and technical requirement)/ V cht lng cng vic xy dng (i chiu vi thit k, tiu chun xy dng v yu cu k thut): Met requirement/ t yu cu c) Other comments, (if any)/ Cc kin khc (nu c): .. .. 5. Conclusion/ Kt lun: - Acceptance agreed, Agreed for Sub-Contractor to carry out next construction works. Kt lun: ng nghim thu, ng cho Nh Thu ph trin khai cc cng vic xy dng tip theo. SCC'S SUPERVISION REPRESENTATIVE GIM ST CA TNG THU SCC SUB-CONTRACTOR'S REPRESENTATIVE I DIN NH THU PH
ENDORSED BY SCC'S PROJECT MANAGER CHNG THC BI GIM C D N SCC
Records of Acceptance For Construction Job/ H s nghim thu cng vic xy dng gm: - Inspection sheets of construction jobs and document attached above Clause 4.a / Bin bn nghim thu cng vic xy dng v cc ti liu nh km theo mc 4.a bn trn; - Related documents used for acceptance/ Cc ti liu lm cn c nghim thu
THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc -------------------------Place (a im):. Date (Thi gian):/../ REQUEST FOR ACCEPTANCE/ PHIU YU CU NGHIM THU: ACCEPTANCE FOR PILE CAP WORKS OF VIADUCT NGHIM THU CNG TC I CC CU CN PROJECT: Ho Chi Minh City Urban Railway Construction Project Ben Thanh - Suoi Tien Section (Line 1) CNG TRNH: D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) 1. Object of acceptance: i tng nghim thu: Piles Cap No. .. At Pier Location. Thi cng i cc s . Ti v tr Tr .
Location : Coordinate/Ta X= . V tr xy dng: Y= 2. Time of Acceptance/ Thi gian mi nghim thu: From/ T: .. (Date/ ngy . month/ thng ... year/nm ..) To/ n:.. At/ Ti:. Construction Site/ Hin trng 3. Bases for acceptance/ Ti liu chun b nghim thu: Decision of Approval for Subcontractor : Ref No Date . Quyt nh ph duyt nh thu ph: S .. Ngy Working Drawing Approved and Design changes Approved :Ref No Date . Bn v thi cng c duyt v nhng thay i thit k c chp thun: S ... Ngy . Method Statement for Construction Approved:Ref No Date . Bin php thi cng c duyt: S Ngy .. Inspection and Testing Plan(ITP) Approved: Ref No.. Date. K hoch kim tra v nghim thu (ITP) c duyt: S ... Ngy . Request for Inspections of General Contractor SCC: As Attached Phiu yu cu kim tra ca tng thu SCC : nh km Technical standard, norm applied: Quy chun, tiu chun c p dng: - Project Employer's Requirement - General Yu cu chung d n ca Ch u t Project Outline Construction Specification - Tiu chun xy dng chung ca d n - TCVN 4453 : 1995: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance TCVN 4453 : 1995: Kt cu btng v btng ct thp ton khi - Quy phm thi cng v nghim thu - Other standards for Material Testing shown in the Project Outline Construction Specification Cc tiu chun th nghim vt liu khc c th hin trong Tiu chun xy dng chung ca d n Test result of material and equipment: Kt qu kim tra th nghim vt liu v thit b: - Test result of material and equipment: As Attached Kt qu kim tra th nghim vt liu v thit b: nh km (Date/ ngy . month/ thng ... year/nm ..)
- Site construction Inspection sheets: As Attached Cc bin bn kim tra hin trng: nh km - Construction diary and other related documents Nht k thi cng v cc ti liu khc lin quan - Internal Acceptance for General Contractor Bin bn nghim thu ni b tng thu Requested by / ngh bi : .. Position / Chc v : . Received by / Tip nhn bi : Position / Chc v : . Date/ ngy dd/mm/yy NJPT comments / kin ca NJPT : Signature / K tn : Signature / K tn :
THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc
a im):. Date (Thi gian):/../ ACCEPTANCE FOR PILE CAP WORKS OF VIADUCT NGHIM THU CNG TC I CC CU CN
ECT: Ho Chi Minh City Urban Railway Construction Project Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot)
lithic concrete and reinforced concrete structures Codes for construction, check
HCMC-260-VDGN-CVS-PLN-00002-E-01
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET PREPARATION DOCUMENTS PHIU KIM TRA CC TI LIU CHUN B
Chainage / L trnh: Pier No. / S hiu tr: Date / Ngy: Time / Gi: Record No.: S ghi nhn:
5.2.1.xx-01
Description (Ni dung) I. Preparation Documents (Ti liu chun b) - Working Drawing Approved and Design changes Approved/ Bn v thi cng c duyt v nhng thay i thit k c chp thun
OK
NG
Remark (Ghi nhn)
- Approved Method Statement for Construction/ Bin php Thi cng c duyt
- Inspection and Testing Plan(ITP) Approved/ K hoch kim tra v nghim thu (ITP) c duyt - Related documents of Construction area plan, Existing Utility Plan (If any)/ Ti liu v a hnh ni thi cng, cc cng trnh tin ch hin hu (nu c). - Approved Design of form-work, of scaffolding, bracing (if any) and temporary work needed for pile cap construction/ Thit k c duyt ca vn khun, dn gio, thanh ging (nu c) v cc cng tc tm cn thit cho thi cng i cc - Source of Material Supply, Location of disposal soil/ Ngun vt liu cung cp cho cng trnh, v tr t thi. II. Another ( Cc vn khc )
Remark (Nhn xt):
Acceptance (Nghim thu):
Accepted (Chp thun)
Not accepted (Khng chp thun)

SUBCONTRACTOR (NH THU PH) Site Engineer (K s cng trng)
GENERAL CONTRACTOR, SCC S REPRESENTATIVE I DIN TNG THU SCC SUMITOMO - CIENCO6 CONSORTIUM Supervision / QC Engineer (Gim st/ k s cht lng)
HCMC-260-VDGN-CVS-PLN-00002-E-02 Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot)
INSPECTION SHEET READY MIX CONRETE (BIN BN KIM TRA B TNG TI)
Chainage / L trnh: Pier No. / S hiu tr: Date / Ngy: Time / Gi: Record No.: S ghi nhn: OK NG Remark (Ghi nhn)
5.2.1.xx-02
Description (Ni dung) I. Checking item (Cng tc) - Concrete grade (Cp b tng) - Concrete supplier (Nh cung cp b tng)
II. Another (Cc vn khc)
Remark (Nhn xt):
Accepted (Chp thun)

Ho Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot) D n Xy dng Tuyn ng st th s 1 TP. H Ch Minh Tuyn Bn Thnh - Sui Tin Gi thu s 2: Xy dng (on trn cao v Depot) CERIFICATE FOR ACCEPTANCE OF CONSTRUCTION JOBS BIN BN NGHIM THU CC CNG VIC XY DNG
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant). Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh SumitomoCIENCO6 (SCC) v c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung).
Construction Jobs Cng vic xy dng
Construction Job No. Cng vic xy dng s Description of Construction Job M t cng vic xy dng Item No. of ITP S ITP Description of Work M t cng vic Date: Ngy:
No. [ ] 5.2.1.xx-01 S 5.2.1.xx-01 Delivery of reinforcing steel bar/sampling for testing Kim tra giao nhn thp/cng tc ly mu thp cho th nghim HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
Subject i tng
Date and Place Thi gian & a im Assessment nh gi
Following have been inspected by parties / Cc ti liu sau c nghim thu bi cc bn:
a) Documents as basis for Inspection / Cc t i liu dng lm cn c nghim thu Working Drawing Approved and Design changes Approved :Ref No Date . Bn v thi cng c duyt v nhng thay i thit k c chp thun: S ... Ngy . Method Statement for Construction Approved:Ref No Date . Bin php thi cng c duyt: S Ngy .. Inspection and Testing Plan(ITP) Approved: Ref No.. Date. K hoch kim tra v nghim thu (ITP) c duyt: S ... Ngy . Request for Inspections of General Contractor SCC: As Attached Phiu yu cu kim tra ca tng thu SCC : nh km Technical standard, norm applied: Quy chun, tiu chun c p dng: - Project Employer's Requirement - General Yu cu chung d n ca Ch u t - Project Outline Construction Specification Tiu chun xy dng chung ca d n - TCVN 4453 : 1995: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance TCVN 4453 : 1995: Kt cu btng v btng ct thp ton khi - Quy phm thi cng v nghim thu - Other standards for Material Testing shown in the Project Outline Construction Specification Cc tiu chun th nghim vt liu khc c th hin trong Tiu chun xy dng chung ca d n
b) Quality of Inspected Work / nh gi cht lng cng vic c nghim thu
c) Inspection of Work on site / Nghim thu thc t ti him trng
No. STT Delivery Sheet Phiu giao hng
Item / Hng mc
Compliance Criteria/tiu chun nh gi Attachment nh km
Test Result/Kt qu Record only Lu tr OK
Conclusion Kt lun
Not OK
Mill Certificate (Lot/heat No./batch/size etc) Chng ch cht lng xut xng (bao gm:l hng, m xut xng, kch c) Sample quantities + Signature Parties S lng mu + ch k cc bn tham gia
Attachment nh km
Record only Lu tr
OK
Not OK
Attachment nh km
Record only Lu tr
OK
Not OK
Taken a photo for witnessing Chp nh ghi nhn chng kin
Attachment nh km
Record only Lu tr
OK
Not OK
Result of Reinforcing steel bar test Kt qu th nghim thp
Attachment nh km
Record only Lu tr
OK
Not OK
d) Comments of NJPT if any / Nhn xt ca NJPT nu c
Inspection Result Kt qu nghim thu
Accepted ng nghim thu Accepted Subject to Rectification of Comments Noted (Note: Punch List is attached) ng nghim thu vi sa cha nh phn Nhn xt (Ghi ch: Danh sch nh km) Not Accepted Khng ng nghim thu Employer's Representative (NJPT) i din Ch u t (NJPT)
SCC Representative Lin danh Sumitomo-CIENCO6
Subcontractor Nh thu ph (Tn cng ty:
Inspector (Gim st)
Supervison / QC Engineer (Gim st/ k s cht lng)
Site Engineer (K s cng trng)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
Ho Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot) n Xy dng Tuyn ng st th s 1 TP. H Ch Minh Tuyn Bn Thnh - Sui Tin Gi thu s 2: Xy dng (on trn cao v Depot)
IFICATE FOR ACCEPTANCE OF CONSTRUCTION JOBS BIN BN NGHIM THU CC CNG VIC XY DNG
ed 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 C and overseen by the Employer and/or the Employer's Representative (General Consultant).
nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomon bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung).
5.2.1.xx-01 5.2.1.xx-01 Delivery of reinforcing steel bar/sampling for testing Kim tra giao nhn thp/cng tc ly mu thp cho th nghim
pected by parties / Cc ti liu sau c nghim thu bi cc bn:
Inspection / Cc t i liu dng lm cn c nghim thu
: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance
Work / nh gi cht lng cng vic c nghim thu
n site / Nghim thu thc t ti him trng
Conclusion Kt lun
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
Rectification of Comments Noted (Note: Punch List is attached) a cha nh phn Nhn xt (Ghi ch: Danh sch nh km)
Signature: Ch k:
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of SumitomoCIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant). Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh SumitomoCIENCO6 (SCC) v c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung).
No. [ ] 5.2.1.xx-02 S 5.2.1.xx-02 Mobilization Equipment of Pile Cap Kim tra cng tc kim tra thit b thi cng i cc HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
Subject i tng
Following have been inspected by parties / Cc ti liu sau c nghim thu bi cc bn:
a) Documents as basis for Inspection / Cc t i liu dng lm cn c nghim thu Working Drawing Approved and Design changes Approved :Ref No Date . Bn v thi cng c duyt v nhng thay i thit k c chp thun: S ... Ngy . Method Statement for Construction Approved:Ref No Date . Bin php thi cng c duyt: S Ngy .. Inspection and Testing Plan(ITP) Approved: Ref No.. Date. K hoch kim tra v nghim thu (ITP) c duyt: S ... Ngy . Request for Inspections of General Contractor SCC: As Attached Phiu yu cu kim tra ca tng thu SCC : nh km Technical standard, norm applied: Quy chun, tiu chun c p dng: - Project Employer's Requirement - General Yu cu chung d n ca Ch u t - Project Outline Construction Specification Tiu chun xy dng chung ca d n - TCVN 4453 : 1995: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance TCVN 4453 : 1995: Kt cu btng v btng ct thp ton khi - Quy phm thi cng v nghim thu - Other standards for Material Testing shown in the Project Outline Construction Specification Cc tiu chun th nghim vt liu khc c th hin trong Tiu chun xy dng chung ca d n
b) Quality of Inspected Work / nh gi cht lng cng vic c nghim thu
Description (Ni dung) I. Equipment (Thit b) - Service crane (Cn cu cng v) - Excavator (Xe cuc) - Steel plate (Tm tn) - Electricity (Cp in) - Formwork (Vn khun) - Tamper (m cc) - Vibrator (My m rung) - Cutting machine (My ct thp) - Bar bender (my un thp) - Welding machine (My hn) - Water pump (My bm nc) II. Another (Cc vn khc)
OK
NG
Remark (Ghi nhn)
Inspector (Gim st)
Supervison / QC Engineer (Gim st/ k s cht lng)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET CHECKING COFFERDAM OF FOUNDATION HOLE (IF REQUIRED) BIN BN KIM TRA KHUNG VY H MNG (NU YU CU) Chainage / L trnh: Pier No. / S hiu tr: Date / Ngy: Time / Gi: Record No.: S ghi nhn: Description (Ni dung) - Sheet piles of cofferdam (cc vn ca khung vy) - Joints of cofferdam (cc lin kt ca khung vy) - Supporting frame of cofferdam (Khung chng ca khung vy) - Stabilizing of cofferdam ( n nh ca khung vy) - Dimensions of cofferdam (Cc kch thc ca khung vy) - Coordinate of corners of cofferdam (Ta cc gc ca khung vy) - Straight of cofferdam ( thng ca khung vy) Conclusion (Kt lun) Remark (Ghi nhn)
I. Checking item (Cng tc)
OK OK OK OK OK OK OK
Not OK Not OK Not OK Not OK Not OK Not OK Not OK
Note /Ghi ch : All checking description will be observed Design drawing of cofferdam which is approved by Employer's Representative. Tt c cc ni dung kim tra s tin hnh theo bn v thit k khung vy c chp thun bi i din Ch u t II. Another (Cc vn khc):
Remark (Nhn xt):
Accepted (Chp thun)

SUBCONTRACTOR NH THU PH
GENERAL CONTRACTOR, SCC S REPRESENTATIVE I DIN TNG THU SCC SUMITOMO - CIENCO6 CONSORTIUM
Supervision / QC Engineer (K s gim st/ k s cht lng)
-VDGN-CVS-PLN-00002-E-05
tion (Line 1)
nh - Sui Tin
o v Depot)
5.2.1.xx-03
Remark (Ghi nhn)
Representative. n Ch u t
pted (Khng chp thun)
s cng trng)
HCMC-260-VDGN-CVS-PLN-00002-E- 06
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET FOUNDATION HOLE ELEVATION, COORDINATE BIN BN NGHIM THU CAO , TA H MNG
5.2.1.xx-04
1. Plan (Hnh v)
ID No S hiu X 1 2 .. ..
Coordinate (Ta ) Design (Thit k) Y X Actual (Thc t) Y Tolerance (Sai lch) X2+Y2
20mm
Elevation (Cao ) Design (Thit k) Actual (Thc t)

Tolerance (Sai lch) 0
Remark (Nhn xt)
Levelling and compaction/ Lm phng v m cht: Hole dewatering/ Bm nc h mng: Remark: (Nhn xt)
OK OK
Accepted (Chp thun)
Supervision / QC Engineer (Gim st/ k s cht lng)
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET CONCRETE PLACING/ SLUMP TEST / TEMPERATURE MEASUREMENT OF LEAN CONCRETE B TNG / TH NGHIM ST B TNG/ O NHIT B TNG LT
Chainage / L trnh: Pier No. / S hiu tr: Date / Ngy: Time / Gi: Record No.: S ghi nhn: Vehicle No. Volume (m3) Bin s xe Khi lng (m 3 ) Number of Samples S lng mu th Name of Sample Tn mu
5.2.1.xx-05
No. S
Starting Time Thi gian bt u
Finishing Time Thi gian kt thc
Slump (mm) st 125 25 (mm)
Concrete Temp. Nhit BT 35C
Remark Ghi nhn
Total (Cng) Remark (Nhn xt):
Accepted (Chp thun)
HCMC-260-VDGN-CVS-PLN-00002-E-08 Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot)
INSPECTION SHEET CONCRETE PLACING RECORD OF LEAN CONCRETE PHIU B TNG LT Chainage / L trnh: Pier No. / S hiu tr: Date / Ngy: Time / Gi: Record No.: S ghi nhn:
5.2.1.xx-06
General Information (Thng tin chung): Concrete Grade (Cp b tng) Design Conc. Vol. (Kh/lg BT thit k) Concrete supply & transport method (Cung cp & vn chuyn b tng): No. (STT) Truck No. Arrival (S xe) (n) Time (Thi gian) Wait (i) Start () Finish (Kt.thc) ; Actual Conc. Vol. (Kh/lg BT thc t) By agitator truck (bng xe ch b tng) Slump ( st) 12525 (mm) Volume (Th tch BT) (m3)
Total Remark (Nhn xt):
Accepted (Chp thun)
GENERAL CONTRACTOR, SCC S REPRESENTATIVE I DIN TNG THU SCC SUMITOMO - CIENCO6 CONSORTIUM Supervision / QC Engineer(Gim st/ k s cht lng)
City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) ng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin age 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot)
INSPECTION SHEET CONCRETE PLACING RECORD OF LEAN CONCRETE PHIU B TNG LT
5.2.1.xx-06
No. of Samples (S lg mu)
SUBCONT RACTOR (NH THU PH)
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET LEAN CONCRETE ELE.& COORDINATE BIN BN NGHIM THU CAO & TA B TNG LT
5.2.1.xx-07
1. Plan (Hnh v)
Coordinate (Ta ) ID No S hiu Design (Thit k) X Y X Actual (Thc t) Y
Elevation (Cao ) Tolerance Tolerance (Sai lch) Design Actual (Sai lch) X2+Y2 (Thit k) (Thc t) 2.0 (cm)
20mm
Remark (Nhn xt)
2 .. .. Remark: (Nhn xt) Acceptance (Nghim thu): Accepted (Chp thun)
SUBCONTRACTOR (NH THU PH)
HCMC-260-VDGN-CVS-PLN-00002-E-10 Ho Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot) D n Xy dng Tuyn ng st th s 1 TP. H Ch Minh Tuyn Bn Thnh - Sui Tin Gi thu s 2: Xy dng (on trn cao v Depot) CERIFICATE FOR ACCEPTANCE OF CONSTRUCTION JOBS BIN BN NGHIM THU CC CNG VIC XY DNG
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant).
Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v c kim tra chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). Construction Jobs Construction Job No. Cng vic xy dng s Cng vic xy dng Description of Construction Job M t cng vic xy dng Subject i tng Item No. of ITP S ITP Description of Work M t cng vic Date: Ngy: No. [ ] S 5.2.1.xx-03 5.2.1. xx -03
Arrangement of steel bars Lp t ct thp HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
Following have been inspected by parties / Cc ti liu sau c nghim thu bi cc bn: a) Documents as basis for Inspection / Cc ti liu dng lm cn c nghim thu Working Drawing Approved and Design changes Approved :Ref No Date . Bn v thi cng c duyt v nhng thay i thit k c chp thun: S ... Ngy . Method Statement for Construction Approved:Ref No Date . Bin php thi cng c duyt: S Ngy .. Inspection and Testing Plan(ITP) Approved: Ref No.. Date. K hoch kim tra v nghim thu (ITP) c duyt: S ... Ngy . Request for Inspections of General Contractor SCC: As Attached Phiu yu cu kim tra ca tng thu SCC : nh km Technical standard, norm applied: Quy chun, tiu chun c p dng: - Project Employer's Requirement - General Yu cu chung d n ca Ch u t - Project Outline Construction Specification Tiu chun xy dng chung ca d n - TCVN 4453 : 1995: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance TCVN 4453 : 1995: Kt cu btng v btng ct thp ton khi - Quy phm thi cng v nghim thu - Other standards for Material Testing shown in the Project Outline Construction Specification Cc tiu chun th nghim vt liu khc c th hin trong Tiu chun xy dng chung ca d n b) Quality of Inspected Work / nh gi cht lng cng vic c nghim thu
c) Inspection of Work on site / Nghim thu thc t ti him trng Plan (Hnh v)
ID No S hiu
Shape Hnh dng
Diameter ng knh (mm)
Spacing Bc ct thp (mm)
Quantity S lng Design Thit k 2 2 2 2 2 2 2 2 2 2 2 2 2 20 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Actual Thc t
Length Chiu di (mm) Design Thit k 12997 12972 12947 12921 12897 12872 12848 12821 12797 12772 12749 12722 12698 13011 7939 7917 7892 7869 7846 7821 7798 7776 7751 7728 7705 7680 7658 7635 7610 7587 Actual Thc t
Total Volume Tng khi lng (m) Design Thit k 25.994 25.944 25.894 25.842 25.794 25.744 25.696 25.642 25.594 25.544 25.498 25.444 25.396 260.220 15.878 15.834 15.784 15.738 15.692 15.642 15.596 15.552 15.502 15.456 15.410 15.360 15.316 15.270 15.220 15.174
1a-1 1a-2 1a-3 1a-4 1a-5 1a-6 1a-7 1a-8 1a-9 1a-10 1b-1 1b-2 1b-3 2 3a-1 3a-2 3a-3 3a-4 3a-5 3a-6 3a-7 3a-8 3a-9 3a-10 3a-11 3a-12 3a-13 3a-14 3a-15 3a-16
20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
3a-17 3a-18 3a-19 3a-20 3a-21 3a-22 3a-23 3a-24 3a-25 3a-26 3b
20 20 20 20 20 20 20 20 20 20 20
2 2 2 2 2 2 2 2 2 2 4
7564 7539 7517 7494 7469 7446 7423 7398 7376 7353 7330
15.128 15.078 15.034 14.988 14.938 14.892 14.846 14.796 14.752 14.706 29.320
4 5 6 7 9
20 20 20 32 32
20 22 40 24 24
7951 14682 9292 15873 14153
159.020 323.004 371.680 380.952 339.672
11 8 10
32 28 25
24 36 36
11700 9240 7319
280.800 332.640 263.484
13 12a 12b-1 12b-2 12b-3 12c 001 002 009
20 16 16 16 16 16 32 32 32
16 4 10 6 6 12 30 30 4
18557 2798 1922 2260 2599 2210 10046 7546 4200
296.912 11.192 19.220 13.560 15.594 26.520 301.380 226.380 16.800
011
32
3814
15.256
006
16
11
7705
84.755
007
12
22
7130
156.860
008 Concrete Cover Space/ Khong cch bo v b tng Splicing length/Chiu di mi ni: Cleaning/V sinh ct thp: Welding & fastening/Hn buc ct thp: Others/Nhng vn khc: d) Comments of NJPT if any / Nhn xt ca NJPT nu c
12
22 OK OK OK OK None
5150
113.300
Inspector (Gim st)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
Ho Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot)
n Xy dng Tuyn ng st th s 1 TP. H Ch Minh Tuyn Bn Thnh - Sui Tin Gi thu s 2: Xy dng (on trn cao v Depot)
ICATE FOR ACCEPTANCE OF CONSTRUCTION JOBS N BN NGHIM THU CC CNG VIC XY DNG
3, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and Representative (General Consultant).
g vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v c kim tra v i din Ch u T (T Vn Chung). 5.2.1.xx-03 5.2.1. xx -03 Arrangement of steel bars Lp t ct thp
i liu sau c nghim thu bi cc bn:
u dng lm cn c nghim thu
and reinforced concrete structures Codes for construction, check and acceptance
ng cng vic c nghim thu
t ti him trng
Total Volume Tng khi lng (m) Actual Thc t
Remark Ghi ch
ments Noted (Note: Punch List is attached) n xt (Ghi ch: Danh sch nh km)
Signature: Ch k:
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant). Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). Construction Jobs Cng vic xy dng Construction Job No. Cng vic xy dng s Description of Construction Job M t cng vic xy dng Item No. of ITP S ITP Description of Work M t cng vic Date: Ngy: No. [ ] 5.2.1.xx-04 S 5.2.1.xx-04 Formwork Coordinate & Elevation/ Centerline on longitudinal, transversal direction Ta v cao vn khun/ Tim dc, tim ngang HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
Subject i tng
I BN THNH
I SUI TIN
Coordinate (Ta ) ID No S hiu Design (Thit k) X 1 2 .. .. Formwork Dimensions (Kch thc vn khun) (m) ID No S hiu 1 2 3 Diemension (Kch thc) H W L Ok Ok Ok Ok Stablility/ n nh: Design (Thit k) Actual (Thc t) Tolerance (Sai lch) +25 mm; -12 mm Y Actual (Thc t) X Y Tolerance (Sai lch) X2+Y2 5mm
Elevation (Cao ) Design (Thit k) Actual (Thc t) Tolerance (Sai lch) 10 (mm)
Remark (Ghi ch )
Flatness/ bng phng: Surface condition/B mt vn khun: Cleaning up/V sinh khun: Spacer Concrete/ Cc k b tng
Lubrication of formwork/Bi trn khun: Hermetic of formwork/ kn kht ca khun: Slant of surfaces of form-work/ nghing mt vn khun None
Others/Nhng vn khc (Refer to Working Drawing/ Tham kho bn v thi cng ):
Inspector (Gim st)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
bruary 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum he Employer and/or the Employer's Representative (General Consultant).
13, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) m xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). 5.2.1.xx-04 5.2.1.xx-04 Formwork Coordinate & Elevation/ Centerline on longitudinal, transversal direction Ta v cao vn khun/ Tim dc, tim ngang
parties / Cc ti liu sau c nghim thu bi cc bn:
n / Cc ti liu dng lm cn c nghim thu
hic concrete and reinforced concrete structures Codes for construction, check and acceptance
h gi cht lng cng vic c nghim thu
im thu thc t ti him trng
I SUI TIN
Remark (Nhn xt)
Ok Ok Ok Ok
tion of Comments Noted (Note: Punch List is attached) nh phn Nhn xt (Ghi ch: Danh sch nh km)
Signature: Ch k:
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET PREPARATION WORK FOR CONRETE PLACING (BIN BN KIM TRA CNG TC CHUN B B TNG )
Chainage / L trnh: Pier No. / S hiu tr: Date / Ngy: Time / Gi: Record No.: S ghi nhn: Description (Ni dung) I. Equipment (Thit b) - Concrete batching plant (Trm trn b tng) - Concrete transport (Vn chuyn b tng) - Concrete Grade (Cp b tng) - Concrete vibrating tamper (m rung) - Concrete penetrating vibrator (m di) - Electricity (Cp in) - Equipment for concreting (Thit b b tng): + Concrete pump (xe bm b tng) + Concrete mixer truck (Xe ch hn hp BT) + Others/ Khc II.Material (Vt liu) - Cement (Xi-mng) - Sand (Ct) - Aggregate (Cp phi) - Water (Nc) - Additive (Ph gia) III. Weather (Thi tit) - Rain (Ma): - Sunshine (Nng) : - Wind (gi) : IV. Another (Cc vn khc) Remark (Nhn xt): Grade 35 OK NG Remark (Ghi nhn)
5.2.1.xx-08
Accepted (Chp thun)
Not accepted (Khng chp thun) SUBCONTRACTOR (NH THU PH)

Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET CONCRETE PLACING/ SLUMP TEST / TEMPERATURE MEASUREMENT OF PILE CAP B TNG / TH NGHIM ST B TNG/ O NHIT B TNG I CC
Chainage / L trnh: Pier No. / S hiu tr: Date / Ngy: Time / Gi: Record No.: S ghi nhn: Finishing Time Vehicle No. Volume 3 (m ) Number of Samples Name of Sample Tn mu Slump (mm) st 100 25 (mm) Concrete Temp. Nhit BT 35C
Air temperature
5.2.1.xx-09
No.
Starting Time Thi gian bt u
Weather
Remark
Khi lng S lng Thi gian Bin s xe kt thc mu th (m 3 )
Nhit khng kh
(Thi tit)
Ghi nhn
Total (Cng) Remark (Nhn xt):
Accepted (Chp thun)
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET CONCRETE PLACING RECORD OF PILE CAP PHIU B TNG I CC
5.2.1.xx-10
General Information (Thng tin chung) Concrete Grade (Cp b tng) Design Conc. Vol. (Kh/lg BT thit k) Curing method (Phng php bo dng) Concrete supply & transport method (Cung cp & vn chuyn b tng): Time (Thi gian) No. Truck No. Arrival (STT) (S xe) (n) Wait (i) Start () Finish (Kt.thc) By agitator truck (bng xe ch b tng) Slump ( st) 100 25 (mm) Conc. Temp. (Nhit BT) 35(C) Volume (Th tch BT) (m3) ; Actual Conc. Vol. (Kh/lg BT thc t)
Total Remark (Nhn xt):
Accepted (Chp thun)

ban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) yn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET CONCRETE PLACING RECORD OF PILE CAP PHIU B TNG I CC
5.2.1.xx-10
No. of Samples (S lg mu)
SUBCON TRACTO R (NH

In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant).
Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). Construction Jobs Cng vic xy dng Construction Job No. Cng vic xy dng s Description of Construction Job M t cng vic xy dng
No. [ ] 5.2.1.xx-05 S 5.2.1.xx-05 Structure completed (Pile Cap) (Checking centerline on longitudinal, transversal direction, Coordinate, Elevation, Dimension..) Nghim thu kt cu hon thnh (i cc) (Kim tra tim dc, tim ngang, ta , cao , kch th HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
Subject i tng
Item No. of ITP S ITP Description of Work M t cng vic Date: Ngy:
I BN THNH
I SUI TIN
Coordinate (Ta ) ID No S hiu Design (Thit k) X 1 2 .. .. Formwork Dimensions (Kch thc vn khun) (m) ID No S hiu 1 2 3 Diemension (Kch thc) H W L Design (Thit k) Actual (Thc t) Tolerance (Sai lch) +25 mm; -12 mm Y Actual (Thc t) X Y Tolerance (Sai lch) X2+Y2 5mm
Elevation (Cao ) Design (Thit k) Actual (Thc t)
Remark (Ghi ch )
Construction Joint between Column & Pile Cap (Mi ni thi cng gia Ct v B mng) Roughening the Construction Joint between Column & Pile Cap/ To nhm mi ni gia ct v b mng Visual shape & Surface Checking (Kim tra hnh dang & b mt) Tolerance/Description (Dung sai/Ni dung) Abrupt irregularitie 5mm; Gradual irregularities<10mm in 2m Straightness/Curvedness ( thng/ cong) Thay i t ngt 5mm Thay i dn u 10mm mi 2m Flatness of horizontal/vertical surface ( phng mt ng/ mt ngang) Repair of visual surface defects (cracks, honeycombs, spalls) (Sa cha cc khuyt tt b mt (nt, r, bc v ..)) Slant of completed surfaces of pile cap ( nghing b mt hon thin ca i cc) d) Comments of NJPT if any / Nhn xt ca NJPT nu c
Inspector (Gim st)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum erseen by the Employer and/or the Employer's Representative (General Consultant).
2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). 5.2.1.xx-05 5.2.1.xx-05 Structure completed (Pile Cap) (Checking centerline on longitudinal, transversal direction, Coordinate, Elevation, Dimension..) Nghim thu kt cu hon thnh (i cc) (Kim tra tim dc, tim ngang, ta , cao , kch thc..)
ected by parties / Cc ti liu sau c nghim thu bi cc bn: Inspection / Cc ti liu dng lm cn c nghim thu
5: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance
ork / nh gi cht lng cng vic c nghim thu
site / Nghim thu thc t ti him trng
Elevation (Cao ) Tolerance (Sai lch) 10 (mm) Remark (Nhn xt)
Remark (Ghi ch )
OK
NG
OK

NG
Rectification of Comments Noted (Note: Punch List is attached) sa cha nh phn Nhn xt (Ghi ch: Danh sch nh km)
Signature: Ch k:
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant). Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). Construction Jobs Cng vic xy dng Construction Job No. Cng vic xy dng s Description of Construction Job M t cng vic xy dng Item No. of ITP S ITP Description of Work M t cng vic Date: Ngy: No. [ ] 5.2.1.xx-06 S 5.2.1.xx-06 Backfilling works of structures Kim tra p tr kt cu HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
Subject i tng
BEN THANH E2
(In accordance with working drawing and method statement which approved by Employer's Representative)
SUOI TIEN E2 E1
E1: Elevation at bottom of excavation E2: Elevation at top of final layer
Foundation
No. Lp
Design Ele. Cao TK (m)
Right side (front)/ Bn phi (trc) Different Density Dung sai T.t (m) cht (mm) Actual
Comment Nhn xt
Left side (behind)/ Bn tri (sau) Different Density Dung sai T.t (m) cht (mm) Actual
1 2 3 4 5 6 7 8 9 10 d) Comments of NJPT if any / Nhn xt ca NJPT nu c
Inspector (Gim st)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
ruary 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum he Employer and/or the Employer's Representative (General Consultant).
3, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v t bi Ch u T v/hoc i din Ch u T (T Vn Chung). 5.2.1.xx-06 5.2.1.xx-06
arties / Cc ti liu sau c nghim thu bi cc bn: n / Cc ti liu dng lm cn c nghim thu
hic concrete and reinforced concrete structures Codes for construction, check and acceptance
gi cht lng cng vic c nghim thu
m thu thc t ti him trng
E1: Elevation at bottom of excavation E2: Elevation at top of final layer
Left side (behind)/ Bn tri (sau) Comment Nhn xt
on of Comments Noted (Note: Punch List is attached) h phn Nhn xt (Ghi ch: Danh sch nh km)
Signature: Ch k:
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant). Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung).
No. [ ] S Reinforcing steel bar testing Kt qu th nghim thp HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
5.2.1.xx-07 5.2.1.xx-07
Subject i tng
No. STT
Designation / K hiu thp
Grade/ Cng
Mechanical Properties/ Tnh cht c hc
Chemical Composition/ Thnh phn ha hc
Evaluation Result/ Kt qu nh gi
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK Attachment/ nh km : d) Comments of NJPT if any / Nhn xt ca NJPT nu c
Not OK
OK
Not OK
OK
Not OK
Inspector (Gim st)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
HCMC-260-VDGN-CVS-PLN-00002-E-17 Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot)
Xy dng Tuyn ng st th s 1 TP. H Ch Minh Tuyn Bn Thnh - Sui Tin Gi thu s 2: Xy dng (on trn cao v Depot)
CATE FOR ACCEPTANCE OF CONSTRUCTION JOBS N BN NGHIM THU CC CNG VIC XY DNG
ebruary 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum the Employer and/or the Employer's Representative (General Consultant).
13, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomo-CIENCO6 (SCC) v xt bi Ch u T v/hoc i din Ch u T (T Vn Chung).
5.2.1.xx-07 5.2.1.xx-07
d by parties / Cc ti liu sau c nghim thu bi cc bn: pection / Cc ti liu dng lm cn c nghim thu
onolithic concrete and reinforced concrete structures Codes for construction, check and acceptance
/ nh gi cht lng cng vic c nghim thu
Nghim thu thc t ti him trng
Evaluation Result/ Kt qu nh gi
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
OK
Not OK
tification of Comments Noted (Note: Punch List is attached) cha nh phn Nhn xt (Ghi ch: Danh sch nh km)
Signature: Ch k:
Ho Chi Minh City Urban Railway Construction Project, Ben Thanh - Suoi Tien Section (Line 1) D n u t xy dng tuyn ng st th s 1 thnh ph H Ch Minh, tuyn Bn Thnh - Sui Tin Contract Package 2: Civil (Elevated & Depot) / Gi thu s 2: Xy dng (on trn cao v Depot) INSPECTION SHEET CONCRETE COMPRESSIVE STRENGTH OF LEAN CONCRETE KT QU TH NGHIM B TNG LT
Chainage / L trnh: Pier No. / S hiu tr:
Date / Ngy: Time / Gi: Record No.: S ghi nhn: Strength Cng ( Mpa ) 7 days 7 ngy 28 days 28 ngy
Average of 28 days ( trung bnh 28 ngy)
5.2.1.xx-11
No TT
Sample No. Mu s
Sample Size Kch thc mu
Casting date Ngy c mu
Testing date Ngy th nghim
Remark Ghi ch
Remark (Nhn xt):
Accepted (Chp thun)
In accordance with Decree No. 15/2013/ND-CP dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 Consoritum (SCC) and checked and accepted by SCC and overseen by the Employer and/or the Employer's Representative (General Consultant). Cn c Ngh nh 15/2013/ND-CP ngy 6 thng 2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh SumitomoCIENCO6 (SCC) v c kim tra v chp thun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). Construction Jobs Cng vic xy dng Construction Job No. Cng vic xy dng s Description of Construction Job M t cng vic xy dng Item No. of ITP S ITP Description of Work M t cng vic Date: Ngy: No. [ ] 5.2.1.xx-08 S 5.2.1.xx-08 Concrete compressive strength of pile cap Kt qu th nghim b tng i cc HCMC-260-VDGN-CVS-PLN-00002Chainage / L trnh: Pier No. / S hiu tr: Place: a im:
Subject i tng
Following have been inspected by parties / Cc ti liu sau c nghim thu bi cc bn: a) Documents as basis for Inspection / Cc t i liu dng lm cn c nghim thu Working Drawing Approved and Design changes Approved :Ref No Date . Bn v thi cng c duyt v nhng thay i thit k c chp thun: S ... Ngy . Method Statement for Construction Approved:Ref No Date . Bin php thi cng c duyt: S Ngy .. Inspection and Testing Plan(ITP) Approved: Ref No.. Date. K hoch kim tra v nghim thu (ITP) c duyt: S ... Ngy . Request for Inspections of General Contractor SCC: As Attached Phiu yu cu kim tra ca tng thu SCC : nh km Technical standard, norm applied: Quy chun, tiu chun c p dng: - Project Employer's Requirement - General Yu cu chung d n ca Ch u t - Project Outline Construction Specification Tiu chun xy dng chung ca d n - TCVN 4453 : 1995: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance TCVN 4453 : 1995: Kt cu btng v btng ct thp ton khi - Quy phm thi cng v nghim thu - Other standards for Material Testing shown in the Project Outline Construction Specification Cc tiu chun th nghim vt liu khc c th hin trong Tiu chun xy dng chung ca d n b) Quality of Inspected Work / nh gi cht lng cng vic c nghim thu
No TT
Sample No. Mu s
Sample Size Kch thc mu
Casting date Ngy c mu
Testing date Ngy th nghim
Strength Cng ( Mpa ) 7 days 7 ngy 28 days 28 ngy

Average of 28 days ( trung bnh 28 ngy)
Inspector (Gim st)
Signature: Ch k:
Signature: Ch k:
Signature: Ch k:
HCMC-260-VDGN-CVS-PLN-00002-E-19 Ho Chi Minh City Urban Railway Construction Project Ben Thanh Suoi Tien Section (Line 1) Contract Package 2: Civil (Elevated & Depot)
RIFICATE FOR ACCEPTANCE OF CONSTRUCTION JOBS BIN BN NGHIM THU CC CNG VIC XY DNG
dated 6 February 2013, following Construction Jobs have been done by subcontractor of Sumitomo-CIENCO6 SCC and overseen by the Employer and/or the Employer's Representative (General Consultant).
2 nm 2013, cc cng vic xy dng sau y c thc hin bi nh thu ph ca Lin danh Sumitomohun bi SCC v c xem xt bi Ch u T v/hoc i din Ch u T (T Vn Chung). 5.2.1.xx-08 5.2.1.xx-08
pected by parties / Cc ti liu sau c nghim thu bi cc bn: r Inspection / Cc t i liu dng lm cn c nghim thu
5: Monolithic concrete and reinforced concrete structures Codes for construction, check and acceptance
Work / nh gi cht lng cng vic c nghim thu
site / Nghim thu thc t ti him trng
Remark Ghi ch
o Rectification of Comments Noted (Note: Punch List is attached) sa cha nh phn Nhn xt (Ghi ch: Danh sch nh km)
Signature: Ch k:

ITP-Pile Caps (Be Tru) (Viaduct) Rev.e - sh01

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ITP-Pile Caps (Be Tru) (Viaduct) Rev.e - sh01

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K Hoch Kim Tra V Nghim Thu Thi Cng i Cc - C

Ngy lp : 7/5/2013 Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tn

K Hoch Kim Tra v Nghim Thu

Bin bn kim tra Th nghim thp

K Hoch Kim Tra V Nghim Thu Thi Cng i Cc - C

Ngy lp : 7/5/2013 Cng tc ti ch i cc bao gm o, B tng lt, Cung cp v Lp t ct thp, Vn khun, b tn

K Hoch Kim Tra v Nghim Thu

H - Thc Hin W - Chng kin TBA - S thng bo sau

SCC - i din tng thu SCC NJPT - i din ch u t

a V Nghim Thu Thi Cng i Cc - Cu Cn

K Hoch Kim Tra v Nghim Thu

Ghi nhn S 5.2.1.xx-03 Ghi nhn S 5.2.1.xx-04

Ghi nhn S 5.2.1.xx-05

Ghi nhn S 5.2.1.xx-09

Ghi nhn S 5.2.1.xx-10 Cng tc xy dng S 5.2.1.xx-05 Cng tc xy dng S 5.2.1.xx-06

Cng tc xy dng S 5.2.1.xx-07

Ghi nhn S 5.2.1.xx-11

n v thc hin th nghim c duyt (TBA)

Cng tc xy dng S 5.2.1.xx-08

a V Nghim Thu Thi Cng i Cc - Cu Cn

K Hoch Kim Tra v Nghim Thu

Inspection and Testing Plan for Pile cap - Viaduct

Employer : Employer's Representative : Contractor :

Inspection and Testing Plan

Checking of Ready Mix Concrete

Delivery of Reinforcing Steel Bar/Sampling for testing

Mobilization Equipment of Pile cap <Sequence of works>

Visual & Measurement

Checking cofferdam of foundation hole (if required)

Every Pile cap

Construction drawing, method statement Construction Drawings

Visual & Measurement

Every Pile cap

Visual & Measurement Slump Test, Checking Temperature Time, Volume

Every Pile cap

Lean Concrete Ele.& Coordinate

Every Pile cap

Visual & Measurement

Every Pile cap

Visual & Measurement

Every Pile cap

Visual & Measurement

Every Pile cap

Visual Slump Test, Checking Temperature Time, Volume

Every Pile cap

Every Pile cap

Visual & Measurement

Every Pile cap

Visual & Measurement

Inspection and Testing Plan for Pile cap - Viaduct

Employer : Employer's Representative : Contractor :

Inspection and Testing Plan

Concrete / Compressive Strength of lean concrete

every 30m3 After 28 days

Concrete / Compressive Strength

every 30m3 After 28 days

Checked by Construction Quality

Name and Position

H - Hold Point W - Witness Point TBA - To be announced

SCC - General Contractor, SCC s Representative NJPT - Employer's Representative

d Testing Plan for Pile cap - Viaduct

Inspection and Testing Plan

d Testing Plan for Pile cap - Viaduct