T&C Form No.

20

FIELD TEST REPORT

Pump Alignment
Project : :
Date of Test :
Unit Designation :
Unit Location :
Sty & Area Served :
Unit Model :
Serial No. :

ACCEPTED RE-INSPECTION REQUIRED

ACCEPTED WITH COMMENTS NOT ACCEPTED

REMARKS / COMMENTS

Installed & Tested By :

XXXXXXX Ltd (Name & Signature) (Date & Time)

Witnessed & Checked By :

(Main-con) (Name & Signature) (Date & Time)

Witnessed & Accepted By :

(M&E RTO/ R.E) (Name & Signature) (Date & Time)

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