INSPECTION & TEST RECORD-CIVIL Rev.

004
ITR No: C-0207A
FOUNDATION COMPLETION CERTIFICATE
2042-ITR-009 Date:
16.01.20

C-0207A Page:
1 of 1

Project No: Record No*:

Tag No.:
Sub-System No:
Drawing No: Rev:
RFI #: Date:
Structure/member:
Area:
Next construction discipline (Tick as Structural steel / equipment installation / underground piping / piping / E&I/ Painting and
applicable) coating

Sl. No. Description of Check Status

Confirm the plan and concrete finished elevation of the foundation is as per IFC
1
drawing (attached survey report)
Confirm that position of Anchor Bolts in plan and elevation is as per IFC drawing
2
(attached survey report)

3 Confirm that the anchor bolt and threads are protected in satisfactory condition.

4 Confirm that the Anchor Bolt pockets to receive grout are cleaned

5 Confirm that post-pour Survey Report of the foundation is accepted

Confirm that surrounding area has been back filled and compacted to correct
6
elevation

7 Confirm that concrete protection reports are available and accepted

8 Confirm that all X-ITR’s have been completed and accepted

Confirm that all construction debris have been removed prior to release to next
9
discipline

10 Confirm that concrete 7 days and 28 days test reports are available and accepted

Remarks:

*If an RFI has 2 # ITRs, record number for those ITRs shall be “RFI number/1” and “RFI number/2” Test reports will have test house
identification numbers.

Company Signature: Applicable Not Applicable

Record Acceptance Sub-Contractor QC PIUL Construction/ QC Company

Name

Signature

Date
Page 1 of 1 Ref. ITP NO: MGP1-CP2-PIL-QA-5733-1003