TITLE:Equipment Gate Pass Form

ASSOCIATED POLICY NO.:HFY-Sec-4.3.5

PROCEDURETITLE:Equipment Pass and Vehicle & Visitor Entry Request Procedure

EQUIPMENT GATE PASS FORM

‫أﺳﺘﻤﺎرة اﺧﺮاج اﻟﻤﻮاد‬

SECTION 1 – ‫اﻟﻘﺴﻢ اﻻول‬

a Date /‫اﻟﺘﺎرﯾﺦ‬ 2021.2.20 ٢٠٢١/٢/٢٠

b From/ ‫ﻣﻦ‬ CPF2 ‫اﻟﻐﺎزﯾﺔ اﻟﺜﺎﻧﯿﺔ‬
c To/ ‫اﻟﻰ‬ CPP Basecamp ‫ﻣﺧﯾﻢ اﻟﺴﻲ ﺑﻲ ﺑﻲ‬
d Driver Name / ‫أﺳﻢ اﻟﺴﺎﺋﻖ‬ Hamid Kareem ‫ﺣﺎﻣﺪ ﻛﺮﯾﻢ ﻧﻌﻤﮫ‬
e Number Plate/ ‫رﻗﻢ ﻟﻮﺣﺔ اﻟﺘﺴﺠﯿﻞ‬ 76953/Baghdad ٧٦٩٥٣-‫ﺑﻐﺪاد‬

SECTION 2 – ‫اﻟﻘﺴﻢ اﻟﺜﺎﻧﻲ‬

Item Description/ ‫اﻟﺘﻘﺎﺻﯿﻞ‬ QTY Remarks / ‫أﻟﻤﻼﺣﻈﺎت‬

Welding Machines
1 2
‫آﻟﺔ ﻟﺤﺎم و اﻟﺔ ﻣﻌﺎﻟﺠﺔ ﺑﺎﻟﺘﺴﺨﻦ‬
Oxygen\Argon\Acetylene 6
2
‫ أﺳﯿﺘﯿﻠﯿﻦ‬/ ‫ أرﺟﻮن‬/ ‫أﻛﺴﺠﯿﻦ‬ bottles
Gas cutting tool
3 1
‫أداة ﻗﻄﻊ اﻟﻐﺎز‬
Welding Cables 5
4
‫ﻛﺎﺑﻞ ﻟﺤﺎم‬ roller
Blind Flange
5 4
‫ﻓﻠﻨﺠﺔ‬
Tools Box
6 1
‫ﺻﻨﺪوق أدوات‬
Reducer
7 3
‫ﻣﺨﻔﺾ‬
Grinders
8 2
‫اﻟﺔ طﺤﻦ‬
Scaffold
9 3 sets
‫ﺳﻘﺎﻟﺔ‬
Bin
10 1
‫ﺳﻠﺔ ﻣﮭﻤﻼت‬
Modified Pipes
11 3
‫اﻻﻧﺎﺑﯿﺐ اﻟﻤﻌﺪﻟﺔ‬

SECTION 3 – ‫اﻟﻘﺴﻢ اﻟﺜﺎﻟﺚ‬

TO BE COMPLETED BY PETROCHINA STAFF ONLY

PetroChina Dept. Contract Holder MAINTAINANCE
Name HAITHAM
Huawei Number 07834958337

Signature

SECURITY BADGING OFFICE

NAME SIGNATURE & STAMP

Osama Ahmed