1 Wi —-4 | 05 pec 2018 A ig aS ae We | STFA - kveSan wecssniccom Nae samen anette, MATERIAL DELIVERED ON SITE FORM [GENERAL [7 NORTH I SOUTH Project 1205060 Contractor STFA ‘Supeirtendent Koc ‘upecrtondents Rep ‘SSH Intemational Date 25-Nov-2018 Reterence 1205080-MDS-1 166 Rev.3 ee Desspon a tera T marine T chitecturat Mechanical Automatic Tank Gauging System ai a FF electrical T Phambing Date of Delivery: it 25-Ju2087 DNNo: 170718 ‘Guanty ‘As por attached Delivery Note (itom No’s— 1, 4, § 11) ‘Specifeation / BOG sause ‘Tecinical Spectication Section 15190 Source & Place af Origin IMIS INCON INC - USAPower Co, Material Suomital Rt. No, 1205050-MAR-0175-2 Rov.0, CCS Activity ‘Storage Location STFA Precast Area STFA QC. ‘Location / Scope of Work Reviewed ‘South and North Harbour Sign. Fema: Di Attachments :- DN, P.O, MAR, Ceticate of Origin, Vendor Reports ‘Submited by: Abdul Aziz Contractor's Signature: FSR — Date: 25-Nov-2018 ‘Superintendents Rep. Comments NOT AP PROVED 4 EPA CURUIPICATE FoR CONGOLE TSE AM TSP-LU2 Is mer SuemaTED /mttAcHED POR KOC ReviEN/APPeOrAL AS MENTIONED IN OUR ComMENT ORb MDS N66, Coy 2 I2- Mopet Foe TTEM No Le WAS NOT MATCH S WITH TIE MODEL wRittEw on Twe DELVERY NOTE: a DESIGNATION NAME ‘SIGNATURE DATE oiscPune suPeRVison (Jue A Aix) 21k DISCPUNE ENGINEER | yChaligl p Jia) 1s (QW/GC MANAGER Goma Set t |——ZhA Shief eur Feceted by Contactor cette Date: Dstibuton By Superintendents Orighal Copy Representative ‘Supeintendent o oo Supesntendents Rep, Gea contactor D —B__ CONTRACTOR WILL PROVIDE COPIES REQUIRED IN THIS FORM. ORIGINAL WILL BE RETURNED TO CONTRACTOR AFTER ACTION TAKEN BY SUPERINTENDENT'S REP, Form No.: 1205050-CTR-FRM-0012_E