HAND OVER / TAKE OVER INSPECTION SHEET

Version 1, 24.01.04 QC Form No. 9

CONTRACT No.: O-2536 INSPECTION No.: Pipe Diameter (mm): FROM MANHOLE / I.C.: MANHOLE / I.C. No.:
MH No. I.C. No.

LOCATION: DATE: Material: TO MANHOLE / I.C.:

COVER LEVEL GROUND LEVEL INVERT LEVEL DEPTH (m)

Type of Manhole / I.C. Material

DESCRIPTION

Concrete with GRP liner from inside and epoxy paint with protection material from outside / Concrete with epoxy inside and out side with protection material on the outside.
OK NOT OK REMARKS

Cover & Frame Adjustment Ring Main Shaft Base Unit Ladder Backdrops Future Port PIPE LINE LENGTH (in m): Encasement of Pipe: Initial Deflection (%): Final Deflection (%):
DESCRIPTION

AVERAGE DEPTH (in m): Concrete Surround / Aggregate Surround / Allowable Deflection (%): Stiffness (N/m2) / Class: Allowable Deflection (%):
OK NOT OK REMARKS

Straightness Leaks General Conditions MANHOLE / I.C. No.: General Notes:

MH No. I.C. No. COVER LEVEL GROUND LEVEL INVERT LEVEL DEPTH (m)

Name: Dr.Ibrahim M. Jameel CONTRACTOR CONSULTANT MACE DORSCH

Signature:

Date:

Client Rep. / Designation Client Rep. / Designation