SITE INSPECTION REQUEST Date 19 August 2021

Ref No. KVLRT3-GSTSB-GS04-EC-SIR-C&S-100598

REQUEST SECTION to be filled by Work Package Contractor (WPC) / Requestor

Name: Izzat Izzuddin Zulkepli Signature and Date:

Designation: Senior Site Engineer

Date of 20 August 2021 Time of Inspection: 10:00 am
Inspection:
Location: EASTERN CORRIDOR

DESCRIPTION OF WORKS for Inspection/Testing: References:

1st STAGE POST TENSIONING WORK FOR PIER P8-08
Work Method Statements: N/A
Inspection and Test Plans: N/A
PIC NAIM : 0173771077
Drawings: N/A
Test Procedures: N/A
Material Submission for Approval: N/A
Others: N/A

INSPECTION SECTION to be filled by Supervising Consultant (S.C) / System Representative / Others

Name: Amiruddin Abdul Kadir Signature and Date:
Designation: ARE

Status: Pass Pass with Comments Fail (Re-Inspect) Cancel

Supervising Consultant (SC)'s / System Representative / Others Comments:

WITNESS SECTION to be filled by MRCBGK (If Applicable)

Witness by: ICM QAQC S&H ENV SYS OTHERS
Name: Signature and Date:

Designation:

MRCBGK’s Comments:

MRCBGK-QAQC-FRM-000010
Rev.01
31 MARCH 2021