Doc. No.

: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT
Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE TEST ON WORKING PILE (ONSHORE) Page: 2 / 10

REVISION HISTORY
REV. DESCRIPTION AND/OR REVISED SHEETS REFERENCE REV. DATE

A First Issue 26 May 2021

B Revised as per Owner's comments (DRS-0-WD800-CZ250-00001-A) 16 Jun. 2021

C Revised as per Owner's comments (DRS-0-WD800-CZ250-00001-B) 20 Aug. 2021

D Revised as per Owner's comments (DRS-0-WD800-CZ250-00001-C) 06 Sep. 2021

E Revised as per Owner's comments (DRS-0-WD800-CZ250-00001-D) 08 Oct. 2021

F Revised as per Owner's comments (DRS-0-WD800-CZ250-00001-E) 01-Nov.2021

0 Revised as per Owner's comments (DRS-0-WD800-CZ250-00001-F) 08 Dec. 2021

1 Revised as per Owner's comments (DRS-0-WD800-CZ250-00001-0) 10 Jan. 2022

 Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT
Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE DRIVING (ON-SHORE) Page: 3 / 10

TABLE OF CONTENTS
CHAPTER PAGE

1. INTRODUCTION 3

2. PURPOSE 3

3 ABBREVIATIONS / DEFINITIONS 3

4. REFERENCES 4

4.1 DOCUMENTS/DRAWINGS 4
4.2 CODES AND STANDARDS 4
5. INSPECTION MODE 4

6. INSPECTION AND TEST PLAN 4

7. ATTACHMENTS

Attachment 1: Field Inspection and Test Plan for Pile Driving (Onshore)
Attachment 2: Format for Material Receiving Inspection Record for Pile Driving(On-shore)
Attachment 3: Format for Field Inspection Checklist (FIC) for Pile Driving
Attachment 4: Format for Survey Field Sheet Record
Attachment 5: Format for Pile Driving Record
Attachment 6: Field Inspection Notification ( FIN )
 Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT
Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE DRIVING (ON-SHORE) Page: 4 / 10

1. INTRODUCTION
Pulau Indah 1200MW Combined Cycle Power Plant (CCPP) Project is a project developed by Pulau Indah Power Plant
Sdn. Bhd. and located in Pulau Indah, Klang Selangor. It is gas fired with 1200MW electrical supply capacity which is
enough to supply 500,000 households in the Klang Valley, Malaysia.

2. PURPOSE
This document is established to provide a standard guideline of Contractor/Owner’s involvement on inspection of related
site activities and testing in order to ensure compliance against design and project specification requirement for good
quality of finished products and acceptance by Owner.

3. DEFINITIONS/ABBREVIATIONS
MPI CCPP PROJECT : Pulau Indah Combined Cycle Power Plant Project
OWNER : Pulau Indah Power Plant Sdn. Bhd.
OWNER’S ENGINEER (OE) : Jacobs Engineering Malaysia Sdn. Bhd.
The OWNER and OWNER’S ENGINEER personnel working as an
OWNER’S TEAM (OT) :
integrated team in delivery of the project
CONTRACTOR : PEC Powercon Sdn. Bhd.
Minconsult Sdn.Bhd ((An Engineering Consultancy Practise (ECP)
Company which Professional Engineer with Practising Certificate
CONTRACTOR'S CONSULTANT : (PEPC) working for or attach to. PEPC is appointed to perform roles
and responsibilities as Submitting Person (SP) under BEM’s
Regulations.

Site Supervision Team which working together with

PEPC under same ECP and being assigned by ECP to
PEPC SITE TEAM
carry out site supervising and reporting roles on behalf
of PEPC
CONTRACTOR'S GEO-CONSULTANT : Fugro Malaysia Land Sdn. Bhd.
SUBCONTRACTOR : Peck Chew Piling Sdn. Bhd.
The area within the boundary of Pulau Indah Combined Cycle Power
SITE :
Plant Project
FIC : Field Inspection Checklist
FIN : Field Inspection Notice
MFS : Minimum Functional Specification

4. REFERENCE DOCUMENTS
4.1 DOCUMENTS / DRAWING
1) 0-WD800-CC290-00002
2) 0-WD800-CC290-00006
3) 0-WD800-CC260-00002
4) 0-WD010-EC260-00045
5) 0-WD010-MZ711-00007
6) 0-WD010-CZ731-00003
7) 0-WD010-MZ711-00001
8) 0-WD010-CZ261-00001
: Method Statement for Pile Driving (Onshore)
: Method Statement for Pile Test on Working Piles (Onshore)
: Technical Specification for Piling Works
: Pile Construction Criteria
: Field Inspection and Test Procedure
: Field Inspection Notice Procedure
: Project Quality Plan
: Welder Qualification Procedure
 Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT
Rev. No.: F
FIELD INSPECTION AND TEST PLAN Rev. Date: 01-Nov.2021
FOR PILE DRIVING (ON-SHORE) Page: 5 / 10

9) MFS B.0.1, B0.2,B14 : Owner's Minimum Functional Specification

10) IFC Drawings : Relevant Latest Revision of Issued for Construction Drawings
Note: All parties are to refer to the latest IFC revision of documents / drawings

4.2 CODES AND STANDARDS

1) AWS D1.1 : American Welding Standards - Structural Welding - Steel

2) BS EN 12699 : British Standards - Execution of Special Geotechnical Work
3) MS 1314-4:2004 : Malaysia Standards - Precast Concrete Piles

5. INSPECTION MODE

The method of inspection and test shall be classified by following terms;

H: Hold point, inspection notification is required. During hold point inspection, the witness will be performed.
Subcontractor / Contractor shall not proceed with the work until presence of the inspector or written consent of
Owner’s inspector.
W: Inspection activities performed by Subcontractor / Contractor and witnessed by Owner’s inspector. Inspection
notification is required. If the Owner’s inspector is not present, Subcontractor / Contractor may perform the
inspection/tests as scheduled unless otherwise requested

SW : Witness, but spot check basis, Inspection notification is required. Initial operation will be witnessed and
subsequent operation will be witnessed at discretion of the Owner’s inspector considering the results of previous
inspection unless otherwise sampling percentage is specified.

M: Monitoring, Contractor / Owner’s Inspector will have all the right to enter fabrication areas of Subcontractor at his
convenient time for the monitoring of Fabrication / Erection activities. Subcontractor is responsible for supporting
his expectations.
R: Review of inspection records and/or specified document.

A : Approval (for Document)

6. FIELD INSPECTION AND TEST PLAN

In details, Field Inspection and Test Plan shall be as accordance to Attachment 1.0 -
Field Inspection and Test Plan for Pile Driving (Onshore)

7. ATTACHMENTS
Attachment 1: Field Inspection and Test Plan for Pile Driving (Onshore)
Attachment 2. Format for Material Receiving Inspection Record for Pile Driving(On-shore)
Attachment 3. Format for Field Inspection Checklist (FIC) for Pile Driving
Attachment 4. Format for Survey Field Sheet Record
Attachment 5. Format for Pile Driving Record
Attachment 6. Field Inspection Notification ( FIN )
Attachment 1
Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE DRIVING (ON-SHORE) Page: 6 / 10

Stage/ Inspection Mode

Acceptance Record/
No. Description Ref. Doc. No. Type of Frequency Remarks
Criteria Evidence Contract Con- Owner
Inspection & Test Sub-Con
or sultant Team

1 Submission

IFC Drawings / Prior to purchasing/ Once or when From approved vendor,

Specification /AWS Visual change of meet specification/code Material Approval
D1.1 /BS EN approved & standard requirement Request (MAR)
Material approval
(e.g.. PHC pile, welding 12699:2015 /MFS material
1.1 B14,MS1314-4:2004 H H R R&A
consumables, coating
material etc.)

IFC Drawings Prior to start piling Each As per Project Transmittal

/Specification, PQP, works/Visual revision/submi Specification/ PQP/ (Approval Status)
HSE Procedure, MFS, ssion IFC Drawings/ HSE
BS EN 12699:2015 Procedure
1.2 Method Statement H H R R&A

IFC Drawings Prior to start piling Each Comply to AWS D1.1, Endorsed records
/Specification /Welder works Visual, procedure and Welder Qualification /reports
Qualification Procedure measurement, welder Procedure /certificates by
/AWS D1.1 testing certified 3rd party
1.3 WPS, PQR, WQT Reports company as per H H R W&A
MFS

H: Hold, R: Review Spec./Record, W: Witness

SW: Spot Witness, M: Monitoring, A: Approval
 Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE DRIVING (ON-SHORE) Page: 7 / 10

Stage/ Inspection Mode

Acceptance Record/
No. Description Ref. Doc. No. Type of Frequency Remarks
Criteria Evidence Contract Con- Owner
Inspection & Test Sub-Con
or sultant Team

2 Incoming Material Inspection, Handling and storage

IFC Drawings, MAR, Prior to pile Every As per approved FIN, Delivery
Specification, Method driving/visual,meas load/pile MAR,adequate Order, Cube Test
Statement for Pile measurement on concrete Report, Material
Driving/ Receiving size,defects,pile strength,correct size Receiving
Inspection Procedure, head and grade,no Inspection Report,
2.1 PHC Spun piles BS EN 12699:2015, condition,concrete defects/damaged Field Inspection H H W W
MS1314-4:2004 strength, Checklist for Pile
Driving

IFC Drawings Prior to pile Every As per approved MAR FIN, Delivery
/Specification /Welder driving/visual,meas delivery/batch ,WPS,valid test Order, Cube Test
Qualification Procedure urement no. certificate Report, Material
/AWS D1.1 Receiving
Welding Inspection Report,
2.2 H H SW SW
consumables(electrode,wire) Field Inspection
Checklist for Pile
Driving

IFC Drawing, Mar, Prior to Pile Every As per approved MAR MAR, Delivery
Specification, MS for Driving / Visual Delivery Order, Cube Test
Pile Driving Report, Material
Receiving
Inspection Report,
2.3 Joint coating material Field Inspection H H SW SW
Checklist for Pile
Driving

H: Hold, R: Review Spec./Record, W: Witness

SW: Spot Witness, M: Monitoring, A: Approval
 Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE DRIVING (ON-SHORE) Page: 8 / 10

Stage/ Inspection Mode

Acceptance Record/
No. Description Ref. Doc. No. Type of Frequency Remarks
Criteria Evidence Con- Con- Owner
Inspection & Test Sub-Con
tractor sultant Team

3 Inprogress Inspection

MS For Survey Works, Prior to start setting Once a Mis-closure within Survey Field
Licensed Surveyor's BM out of pile Month/or minimum accuracy Sheet
Survey Drawing, setting point/visual, when requirement. Survey
out plan for critical measurement observed equipment with valid
Site TBM /Control stations
3.1 dimension of each disturbance calibration certificates H H R R
checking
facility

MS For Survey Works, Prior to pile Every pile As per design Survey Field
IFC Drawings, driving/visual, coordinate in IFC Sheet
Specification measurement Drawings. Survey
equipment with valid
Setting out and pegging of
3.2 calibration certificates H H R R
pile points

MS For Pile Driving Prior to driving/visual Every pile Pile in good condition, in FIN, pile driving
,measurement /point tolerance of position and record, Field
verticality tolerance as per Inspection
IFC Checklist for Pile
Pitching of pile to position
Drawings/Specification. H H SW SW
3.3 -Verticality check Driving
-Position check

H: Hold, R: Review Spec./Record, W: Witness

SW: Spot Witness, M: Monitoring, A: Approval
 Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE DRIVING (ON-SHORE) Page: 9 / 10

Stage/ Inspection Mode

Acceptance Record/
No. Description Ref. Doc. No. Type of Frequency Remarks
Criteria Evidence Contract Con- Owner
Inspection & Test Sub-Con
or sultant Team
MS For Pile Driving, IFC During driving/visual, Every pile/point As per approved driving FIN, pile driving
Pile Driving Drawing, Specification, measurement criteria .No. of blows are record, Field
- Verticality of Pile approved set calculation/ recorded for every 250mm Inspection Checklist
- Hammer weight and drop BS EN 12699:2015 penetration for Pile Driving
3.4 H H W SW
height
- No. of blows/300mm
penetration

WPS,WQT,MS For Pile Pre, during & post Every Joint Full continuous butt weld,
Driving, AWS D1.1/ IFC welding/Visual, no porosity, free from
Drawings, Approved MAR measurement slags. Welded by
Welding of pile joints qualified welders using FIN, pile driving
-Surface preparation(free from correct size, type and record, Field
3.5 approved electrode/wire
H H SW SW
dust, dirt, rust, oil etc.) Inspection Checklist
-Steel surface in dry condition as per WPS for Pile Driving

Welding of Pile Joints
3.6
- Magnetic Particle Test (MPI)
AWS D1.1 Clause 6.10 Post Welding/ Visual, 2 joints per Full continuous butt weld, FIN, Test Report
Technical Spec. for Pile Field Test week per welder no porosity, free from
Driving Work slags. Welded by
MS for Pile Driving qualified welders using
(Onshore) - Supplementary correct size, type and H H SW SW
Doc. No. 0-WD800-CC261- approved electrode/wire
00002 as per WPS

MS For Pile Driving, IFC Prior to and after Every Joint Free from weld slags FIN, Field
Drawing, Specification, coating/Visual Acceptable Inspection Checklist
Approved MAR thickness(min.2 for Pile Driving
Coating of pile joint with anti coats),touch dry and by
3.7 H H SW SW
corrosion material approved material

MS for Pile Driving, IFC End of Driving (EOD - Every pile/point As per Pile Construction Pile Driving
Drawings, 0-WD010- Length as per IFC Criteria, No. of Final Record, Field
EC260-00045 Pile Drawings)/Visual, Blow is as per approved Inspection Checklist
3.8 Pile Termination H H W SW
Construction Criteria measurement calculation from 0- for Pile Driving,
WD010-EC260-00045 FIN
Pile Construction Criteria

H: Hold, R: Review Spec./Record, W: Witness

SW: Spot Witness, M: Monitoring, A: Approval
 Doc. No.: 0-WD800-CZ250-00001
PULAU INDAH COMBINED CYCLE POWER PLANT Rev. No.: 1
FIELD INSPECTION AND TEST PLAN Rev. Date: 10 Jan. 2022
FOR PILE DRIVING (ON-SHORE) Page: 10 / 10

Stage/
Acceptance Record/
No. Description Ref. Doc. No. Type of Frequency Remarks
Criteria Evidence Contract Con- Owner
Inspection & Test Sub-Con
or sultant Team
MS For Pile Driving, MS During and post Every close Heaving not exceeding Survey Field Sheet
Heaving monitoring for Survey Works, driving/Visual, adjacent piles 15mm
3.9 Specification measurement less than 1m
H W R R
-Survey
spacing

4 Final Inspection

IFC Drawings, MS For After completed pile Every pile Deviation of position-not Survey Field Sheet,
Survey Works, installation, prior to /point exceeding 75mm in any
Specification cutting/Visual, direction.
measurement Deviation of verticality
As-built Survey not exceeding 1:75
4.1 -Measure position (at C.O.L) subject to design H H R R&A
-Measure verticality provision. Valid survey
instruments calibration
certificates

5 Final Documentation

Project final Completion of Every pile All related documents has Signed Handover
documentation/handover works/Visual /point been verified and dossier by Owner
procedure endorsed by relevant
parties including licensed
5.1 As-built drawings surveyor as per H H R R&A
project/regulation
requirement

Project final Completion of Every pile All related documents has Signed Handover
documentation/handover works/Visual /point been verified and dossier by Owner
procedure compiled by relevant
parties as per handover
dossier
5.1 Quality Records H H R R&A

H: Hold, R: Review Spec./Record, W: Witness

SW: Spot Witness, M: Monitoring, A: Approval
Attachment 2

PULAU INDAH CCPP

Material Receiving Inspection Record
for Pile (On-shore)

PROJECT INFORMATION
Item / Material Report No. PI-MRI-C-21-XXXX
Drawing No. Inspection Date
FITP No. 0-WD800-CZ250-00001 FIN No.
MAR No.

SECTION A : MATERIAL RECEIVING

Supplier D.O. No.
Location P.O. No.
▶Receiving Inspection
No. Description of Material Type Size Quantity

Acceptance
No. Descriptions
Yes No Method Remarks
The delivered piles are:

1 ( i ) From the approved supplier/manufacturer Visual

( ii ) As per approved Material Approval Request (MAR) Visual

Check Pile appearance

2 (ⅰ) Honeycomb Visual

(ⅱ) Ensure the piles are straight, free from
Visual
distortion and accidental damage
Check Tolerance in Spun Pile Dimension
( i ) Pile Length for up to 12m piles = (+/- 25mm) Ruler
( ii ) Cross Sectional Dimensions:
a) nominal external diameter (-3 mm to +6mm) Ruler
b) concrete wall thickness of hollow section (-3mm to +15mm) Ruler
3 (Ex. = Try Square)
Pile Head Squareness(+/- 5mm) Ruler
Straightness - Any face of piles shall not deviate by more than 6mm
from a straight edge 3m long laid on the face, and the centroid of
any cross section of the pile shall not deviate by more than 12mm Ruler
from the straighht line connecting the centroids of the faces of the
pile.
4 Cracks(=<0.05mm) or Damages on Piles Visual
5 Compressive Strength Test Result/report) Result/Report from Supplier

6 Condition of Pile Surface and Pile Head Visual

Size, class, type ,length, and quantity of piles are as per Delivery
7 Visual
Order
Ensure piles are stack in accordance to manufacturer's
8 Visual
recommendation

SECTION B : MATERIAL INSPECTION AND VERIFICATION

COMMENTS : RESULTS :
□ Accepted
□ Rejected
□ Accept with Comments
PREPARED BY CHECKED BY WITNESSED BY ACKNOWLEDGED BY
(Sub-Contractor) (Contractor/QAQC) (Contractor's Consultant) (Owner's Team)
Name : Name : Name : Name :

Signature : Signature : Signature : Signature :

Date : Date : Date : Date :

Form No. : C-PD-CL-001 / Rev. 0 / Date : 06.Dec.2021

Attachment 3

PULAU INDAH CCPP

Field Inspection Checklist (FIC)
for Pile Driving

FIN No. Date

FITP No. 0-WD800-CZ250-00001 Reference Dwg.
Attachment □ Yes □ No
Inspection
(Item or Location)
▶Inprogress Inspection
Checking
No. Description Yes No Remarks
Method
Check quality of pile
(ⅰ) Honeycomb Visual
(ⅱ) Ensure no crack line Visual

1 (ⅲ) Ensure the piles are straight, free from distortion and accidental damage Visual

(ⅳ) Ensure piles are stack in accordance to manufacturer's recommendation Visual

(ⅴ) Free from defects or damage prior to pitching for driving Visual

2 Check platform levels before piling Survey

3 Check pile point location Survey
□ SSP
4 Check pile manufacturer's used for the location. Visual
□ ICP
5 Check pile shoe Visual
6 Pile length marking at every 250mm Visual

7 Check verticality of pile by using spirit level or plumb bobs Visual / Survey

Pile Driving

Observe and check hammer size and drop height as per approved driving
(ⅰ) Visual
criteria
8
Pile Termination as per approved IFC Drawings and document no. 0-
(ⅱ) Visual
WD010-EC260-00045 Pile Construction Criteria

(ⅳ) Check the deviation of piles from original position Survey

Welding of Pile Joints (WPS, Doc. No.: 0-WD800-CC261-00001 )

Ensure the surface to be welded shall be free
(ⅰ) Visual
from rust, grease and dirt
(ⅱ) Remove weld slags between inter-run passes Visual
Welding is done in complete passes with convex surface finish profile as
(ⅲ) Visual
approved WPS)
(ⅳ) Ensure slags are removed prior to painting for weld joints Visual

Welding joint to be painted with 2 coats of oxide paint before driving

(ⅴ) Visual
continues
9
(ⅵ) To ensure sufficient cooling time prior to apply paint (Min. 8 minutes) Visual

Wind shield/breaker is used to prevent wind disturbance during welding

(ⅶ) Visual
works
Correct size, type and class of welding wires / electrodes being used as
(ⅷ) Visual
per approved WPS
Welding of pile joint is performed by qualified welders with valid welding
(ix) Visual
certificate
to attach welder ID and joint no. if test has
(x) Magnetic Particle Test Test been carried out.

10 Pile is terminated as per designed length/Pile Construction Criteria Visual

11 Ensure the piling record sheet is completed. Visual
12 Check the pile cut-off level Survey
COMMENTS

PREPARED BY CHECKED BY WITNESSED BY ACKNOWLEDGED BY

(Sub-Contractor) (Contractor/QAQC) (Contractor's Consultant) (Owner's Team)
Name : Name : Name : Name :

Signature : Signature : Signature : Signature :

Date : Date : Date : Date :

Form No. : C-PD-CL-002 / Rev. 1 / Date : 30.Dec.2021

ATTACHMENT 4
PULAU INDAH CCPP
Survey Field Sheet Record

Report No. Date

Ref. Drawing FIN No.

Structure/Location Page No. /

Description of Survey
▶ Datum
Bearing Horizontal Coordinates
Station To Remarks
Degree Minutes Seconds Distance N E

▶ Survey Record
Design Actual Deviation
No. Items Coordinate Level Coordinate Level Horizontal (mm) Vertical (mm) Remark
N E Z N E Z N E Z

REMARKS:

PREPARED BY CHECKED BY WITNESSED BY ACKNOWLEDGED BY

(Sub-Contractor) (Contractor: QAQC/Surveyor) (Contractor's Consultant) (Owner's Team)

Name : Name : Name : Name :

Signature : Signature : Signature : Signature :

Date: Date: Date: Date:

NOTES: Survey record shall be attached with relevant latest IFC Drawings Form No. : PI-PEC-FORM-001 / Rev. 0 / date : 09.Nov.2021
Attachment 4
PULAU INDAH CCPP
Survey Report - ref. DWGs

Form No. : PI-PEC-FORM-001 / Rev. 0 / date : 09.Nov.2021

ATTACHMENT 5
Attachment 6

PULAU INDAH CCPP

Field Inspection Notification ( FIN )

Activity Sub-Contractor

FIN No. Issued Date

Rev. No. Discipline

Please be invited to attend the following inspection according to the following schedules:

Inspection Details

No. Inspection / Testing Description Location Date / Time

Reference Documents

FITP No. Drawing No.

Spec. No. Others

Contractor/QAQC Hold Point Witness Spot Witness

Inspection
Contractor's Consultant Hold Point Witness Spot Witness
Mode
Owner's Team Hold Point Witness Spot Witness

Contractor's QAQC Owner's Team

Name : Name :
ACKNOWLEDGEMENT OF RECEIVED
Signature : Signature :

Date : Date :

INSPECTION STATUS (To be completed after the inspection)

Inspection Item

□ Inspection Passed. The Testing / Inspection is satisfactory and works may proceed to the next stage
□ Remedial works listed below to be completed and inspection is required after remedial works
□ Remedial works listed below to be completed but no further inspection required
□ Rejected
※ New FIN raised? ☐Yes ☐ No New FIN No.:
REMARKS:

ACKNOWLEDGEMENT OF INSPECTION
PREPARED BY CHECKED BY WITNESSED BY ACKNOWLEDGED BY
(Sub-Contractor) (Contractor/QAQC) (Contractor's Consultant) (Owner's Team)

Name : Name : Name : Name :

Signature : Signature : Signature : Signature :

Date : Date : Date : Date :

Form No. : 5PG-0701-012-F1 / Rev.0 / Date : 04.Oct.2021