NATIONAL WATER COMPANY ‫ﺷﺮﻛﺔ اﻟﻤﯿﺎه اﻟﻮطﻨﯿﺔ‬

Project Name\ /‫اﻟﻤﺸﺮوع‬

Consultant\ /‫اﻹﺳﺘﺸﺎري‬
Contractor Consultant
Contractor\ Logo Logo /‫اﻟﻤﻘﺎول‬
RECORD OF ASPHALT LAYING ‫ﺳﺟل أﻋﻣﺎل اﻷﺳﻔﻠت‬
S. No.:
Inspection Date Time Location
‫ﺗﺎرﯾﺦ اﻟﻔﺣص‬ ‫اﻟوﻗت‬ ‫اﻟﻣﻛﺎن‬
Line No. ‫رﻗم اﻟﺧط‬ Quarter‫اﻟﺣﻲ‬ Street
From MH/ Ch To MH/ Ch ‫اﻟﺷﺎرع‬
BoQ No. Drawing No. ‫رﻗم اﻟﻣﺧطط‬
We certify that these works has been executed in accordance with the Contract Specifications and Approved Drawings
‫ﻧﺷﮭد ﺑﺄن اﻷﻋﻣﺎل اﻟﻣذﻛورة أﻋﻼه ﻧﻔذت ﺣﺳب ﻣواﺻﻔﺎت اﻟﻌﻘد و ﺣﺳب اﻟﻣﺧططﺎت اﻟﻣﻌﺗﻣدة‬

Contractor's QA/QC Engineer ‫ﻣﮭﻧدس اﻟﻣﻘﺎول ﻟﺿﺑط اﻟﺟودة‬ Signature & Date ‫اﻟﺗوﻗﯾﻊ و اﻟﺗﺎرﯾﺦ‬

RECORD OF INSPECTION
Base Course Inspected and Approved ‫ﻓﺣص طﺑﻘﺔ اﻷﺳﺎس اﻷوﻟﻰ و اﻟﻣواﻓﻘﺔ ﻋﻠﯾﮭﺎ‬

Base Course Thickness ‫اﻟﺳﻣﺎﻛﺔ‬ mm

Wearing Course Inspected and Approved ‫ﻓﺣص طﺑﻘﺔ اﻷﺳﻔﻠت اﻷﺧﯾرة و اﻟﻣواﻓﻘﺔ ﻋﻠﯾﮭﺎ‬

Wearing Course Thickness‫اﻟﺳﻣﺎﻛﺔ‬ mm

GENERAL REMARKS BY THE CONSULTANT ‫ﻣﻼﺣظﺎت اﻹﺳﺗﺷﺎري اﻟﻌﺎﻣﺔ‬

Approved Not Approved

ACCEPTED BY: NAME SIGNATURE DATE

Contractor Representative
Consultant Representative