MATERIAL INSPECTED THIS VISIT

Item Quantity Description Tag No., Batch No.,

Code Serial No., Cast,
Heat No.
Witnessed Burst Test for Cylinders
1 L 5816
(Batch No. LPG/48 L/3059 - SR.No: L 5626 — L 6028
Witnessed Burst Test for Cylinders
1 L 6218
(Batch No. LPG/48 L/3059 - SR.No: L 5626 — L 6028
Witnessed Burst Test for Cylinders
1 L 6618
(Batch No. LPG/48 L/3059 - SR.No: L 5626 — L 6028
--
Witnessed Burst Test for Cylinders
1 L 7015
(Batch No. LPG/48 L/3059 - SR.No: L 5626 — L 6028
Witnessed Burst Test for Cylinders
1 A 23451
(Batch No. LPG/108 L/415 - SR.No: A 23416 — A 23818
Witnessed Burst Test for Cylinders
1 A 24017
(Batch No. LPG/108 L/416 - SR.No: A 23819 — A 24221
RESULTS OF Accepted Not ORDER STATUS: Complete Incomplete
INSPECTION: Compliant
1.0SUMMARY:
Inspection visit was made at Haifa Industrial Services Co LLC. Workshop ,Rusayl to witness Burst Test per the
client’s request.

Please refer Page 02 & 03 for more details about inspection.

Balance Full PO
ATTACHMENTS: NCR Punchlist Partial Release
Release Release
RECORD OF HOURS
Vendor / Report Hours: 1 Visit Travelling Hours: Distance Travelled:
Inspecting Engineer: Rahul M Reviewed by: Girish Kumar HM Agreed Expenses: Yes No

Date: 21.12.2017 Date: 21.12.2017 Page 1 of 3

L5-FMT-046 Rev. 03
 THE VELOSI GROUP
Inspection Report
Continued
Client: Haifa Industrial Services Co LLC PO No.: 17000808 Page 2 of 3

1.Report Headings: 2.Persons Present 3.Documentation Used /Approval Status 4.Inspection Carried Out 5.HSE Feedback
on the Vendor 6.Results/Conclusions 7.Overall Order Status 8.Next Visit/Exit Call 9.Attachments/Photos

2.0 PERSONS PRESENT:

 Mr.Yogindhar - Haifa Industrial Services Co. LLC.
 Mr. Rahul Moottolikandy - TPI, Velosi Oman LLC

3.0 DOCUMENTATION USED / APPROVAL STATUS:

 OS 120:1986

4.0 INSPECTION CARRIED OUT (reference ITP clause if applicable):

 Witnessed Burst Test for the below mentioned cylinders with Achieved Result :-

Burst Standard
Cylinder
Pressure
Capacity Serial No.
Achieved
(Liter)
(Bar)
48 L 5816 80.62 OS 120:1986
48 L 6218 76.12 OS 120:1986
48 L 6618 77.62 OS 120:1986
48 L 7015 79.12 OS 120:1986
108 A 23451 70.62 OS 120:1986
108 A 24017 70.62 OS 120:1986

 Burst test pressure value for above all meets the standard requirements - Found accepted.
 Verified & Reviewed calibration certificate of pressure gauge - Found valid.

 CALIBRATION OF INSTRUMENTATION USED:

Type of Equipment Manufacture Serial N° Date Last Current Calibration

r Calibrated Calibration Expiry Certificate N°
Date
Pressure Gauge CALTROLS 150856383 23/04/2017 22/04/2018 --

5.0 HSE FEEDBACK ON VENDOR: General HSE is followed by the client.

6.0 RESULTS / CONCLUSIONS: Satisfactory .

7.0 OVERALL ORDER STATUS: Ongoing

DELIVERY:

PO Delivery Current Scheduled Delivery Delivery Point Comments

Date
N.A N.A N.A N.A

8.0 NEXT VISIT / EXIT CALL (must give estimated date if no fixed date; include stage/activity details): TBA

L5-FMT-046 Rev. 03
 THE VELOSI GROUP
Inspection Report
Continued
Client: Haifa Industrial Services Co LLC PO No.: 17000808 Page 3 of 3

1.Report Headings: 2.Persons Present 3.Documentation Used /Approval Status 4.Inspection Carried Out 5.HSE Feedback
on the Vendor 6.Results/Conclusions 7.Overall Order Status 8.Next Visit/Exit Call 9.Attachments/Photos

9.0 ATTACHMENTS: PO 17000798

- End of Report -

L5-FMT-046 Rev. 03