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QUALITY CONTROL FORM

QCF 108

PROJECT

CLIENT

DUNG QUAT REFINERY ( DQR ) PROJECT


VIETNAM OIL AND GAS CORPORATION
(PETROVIETNAM )

GROUTING INSPECTION REPORT


ITEM:

___________________________________________________________

DRAWING No.

_______________________________

UNIT / AREA

REV. ______

SH__ OF __

_______________________________

GROUT TYPE:
CEMENT BASED TYPE G1

Brand _____________________

THK mm________________

EPOXY TYPE G2

Brand _____________________

THK mm________________

CEMENT BASED TYPE G3

Brand _____________________

THK mm________________

INSPECTIONS
S/ N
1.

DESCRIPTION

ACC

NOT ACC

REMARKS

GROUTING APPROVAL

2.

SURFACE PREPARATION
AND SOAKING TIME

3.

FORM WORK

4.

PLACEMENT START

5.

PLACEMENT FINISH

6.

EXPANSION JOINT

7.

REINFORCEMENT

8.

SAMPLE TAKEN

9.

CURING

REMARKS

TEST RESULT:
ACCEPTED
NOT ACCEPTED
SUBCONTRACTOR
NAME
SIGNATURE
DATE

/var/www/apps/conversion/tmp/scratch_3/171081970.doc

CONTRACTOR

CLIENT

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