SAUDI ARAMCO MOBIL REFINERY CO., LTD.

INSPECTION & EQUIPMENT RELIABILITY SECTION

REQUEST Inspection Form
REFERENCE FOR INSPECTION No. 03
FEQA TO BE RAISED BY MAINTENANCE / CONTRACTOR RFI NO:
PROCEDURE AND THEN TO BE SUBMITTED TO AFL-009
INSPECTION GROUP LEADER
T8-020 Date :
7/18/2020

TSR / W.O No. : 5787620 PROJ. / MAINT. ENG. : Hassan Al-Harbi

TSR / W.O Title : Berth 54 Underdeck Piping Replacement CONTRACTOR : Arabian Fal Company
Equipment / Line : Flush Upgrade Equipment / Line No :

INSPECTION REQUISITION

DESCRIPTION: DATE REQUIRED: 18-Jul-20

APPROXIMATE TIME
AVAILABLE FOR
Material verification & Receiving of Filler INSPECTION : 8:30 AM
Wire for Flush Upgrade line.

REQUESTED BY: ISRAR HUSSAIN Arabian Fal QC Inspector

NAME COMPANY POSITION

APPROVED BY:
MAINTENANCE / OPERATIONS / CONTRACTOR SUPERVISOR

INSPECTION ASSIGNMENT (TO BE COMPLETED BY INSPECTION GROUP)

INSPECTION GROUP LEADER'S INSTRUCTIONS:

INSPECTORS

TYPE OF INSPECTION PERFORMED:

DATE COMPLETED:

INSPECTION REPORT NO. OR

ANY OTHER ACTION RECOMMENDED:

DOES A FOLLOW-UP INSPECTION IS REQUIRED: YES NO

FEED BACK: INSPECTOR APPROVED: INSPECTION GROUP LEADER

NAME: NAME:

SIGNATURE: Date: SIGNATURE: Date: