HHR-QR-RIO Rev.

Form 13.6

PROJECT:
S08139 - Al Haramain High Speed Rail Phase 1, Package 1

EMPLOYER:

Request No. HHR-A6-AJV-ST-RIVDate 20-Jan-13

ENGINEER :

CONTRACTOR :

REQUEST FOR INSPECTION

We request your attendance to inspect the following works : 1. TYPE : 3. LOCATION :
Buildings Roads Infrastructure Other

2. INSPECTION TIME :

12:00 NN Zone MADINAH

First

DATE : Road
Second

21-Jan-13 Stations/Nodes Sta. 433+387

Third

Drawing No.

4. INSPECTION :

5. DESCRIPTION OF WORKS :

Inspection of Reinforcing Steel Bars for Part 10 RHS Retaining Wall at Underpass 433+387
6. The works involve the following trades (Tick more than one if required) :
Surveying Architectural Civil Electrical Mechanical Others (specify)

For the Contractor

Received for the Engineer's Representative

Name & Signature: Date:

Eng. Usama Mammoun

Name & Signature: Date: SIGNATURE:

7. INSPECTION REPORT :
Surveyor

Architect Material Engr.

Civil/Structural Engr. Geotechnical Engr. Electrical Engr. Mechanical Engr.

Date/Time of Inspection : 8. ENGINEER'S REPRESENTATIVE'S COMMENTS :

The works are :

Approved

Approved as Noted

Rejected

Signature ___________________________________ ATTACH ALL RELEVANT PARTICULAR TEST FORMS

DATE :

Approval shall not relieve the Contractor of his liabilities under the Contract or constitute authorization of any change to the Contract Documents