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DOHA EXPRESSWAY PACKAGE

ORBITAL HIGHWAY P023-0003

INSPECTION REQUEST (IR)


-SECTION 1: CONTRACTOR
NOTIFICATION

IR NO: EXW-P023-0003-CI-LAJ-IR- 03555 Rev: CA BOQ No: RFVO-04 Rev: 3 ITP Item No: C (W)
ITP Ref:EXW-P023-0003-CI-LAJ-IT-00002 Rev: CA Title: Road Crossing Duct Bank
Earthworks Sub Base/Base Asphalt Works Structures Utilities M&E Other (State):
DISCIPLINE:
DRAWING No: CN 20011 Rev:SH. 10F1 PREVIOUS ACTIVITY IR No:
EXW-P023-0003-EE-LAJ-DG-75203-056 Rev: CA EXW-P023-0003-CI-LAJ-IR-03471 CA
LOCATION: NEAR TO JUNCTION-8
DESCRIPTION OF ITEM / ACTIVITY TO BE INSPECTED

PIPE LAYING AND CONCRETE PRE POUR INSPECTION FOR OOREDOO (4XD54) DUCT CROSSING AT
CH: 50+734 ( P1 TO P9)

Date/Time Submitted: 20/10/2015, 3:00 PM Date/ Time of Inspection: 21/10/2015, 4:00 PM


The issuer confirms that the Item/Activity is ready for inspection.
LAJ CONSTRUCTION / SUBCONTRACTOR LAJ QC ENGINEER/ INSPECTOR MOTT MACDONALD
Name: ROY BARRION Name: MICHAEL BAGO Name:
Signature: Signature: Signature:
Position: Site Engineer Position: QA/QC ENGINEER Position:
Contact No: 33050028 Contact No: 70359558 Contact No:
Date: 20/10/2015 Date: 20/10/2015 Date:
SECTION 2: SUPERVISION CONSULTANT
SUPERVISION CONSULTANT INSPECTION COMMENTS

Received By Supervision Consultant: Date/ Time Received:


POSITION NAME SIGNATURE DATE COMMENTS

SURVEYOR

SITE
INSPECTOR

MATERIAL
ENGINEER/
INSPECTOR
QA/QC
ENGINEER/
INSPECTOR

ARE/ RE

SECTION 3: INSPECTION RESULT


APPROVED EXCEPT AS NOTED B
APPROVED A (SEE SECTION 4) NOT APPROVED W
SENIOR RESIDENT ENGINEER: SIGNATURE: DATE:
SECTION 4: APPLICABLE ONLY FOR APPROVED EXCEPT AS NOTED

APPROVED A REJECTED W
SENIOR RESIDENT ENGINEER: SIGNATURE: DATE:
SECTION 5: INSPECTION REQUEST RECEIVED BACK BY THE CONTRACTOR
CONTRACTOR REPRESENTATIVE: SIGNATURE: DATE:
(W) Witness Point: Contractor may proceed if SC is not
(H) Hold Point: Contractor must not proceed without approval
present for inspection as scheduled.

Inspection Request (IR) (EXW-P023-0003-QM-LAJ-FO-00001)


Revision CE - Date: 19/04/2015