MBAC

Contractor:
Contract Title: Mine Infrastructure & Utilities

INSPECTION REQUEST (IR)

IR REF. :

REV: 0

TO

DISCIPLINE

LOCATION
SYSTEM
DRWG/SPEC.
REF
ATTACHMENTS

DATE ISSUED:

MEP

ACTIVITY

FUEL DISPENSER AND TANK

AREA
SUBYSTEM

LIGHT VEHICLE REFUELLING

STATION

:
:

MD-

YOU ARE HEREBY REQUESTED TO INSPECT OUR WORK AS LISTED BELLOW ON 26/07 / 2015 AT 08 :30 am HRS ONWARDS

WORK TO BE
INSPECTE
D

INSTALLATION OF FUEL DISPENSER, DAY TANK AND

SUBMERSBILE PUMP AT REFUELLING STATION

WE CERTIFY THAT ALL TEMPORARY AND FALSE WORKS ASSOCIATED WITH THIS WORK ACTIVITY HAVE BEEN ERECTED AND
INSPECTED BY A SUITABLY QUALIFIED AND EXPERIENCED PERSON AND/OR ORGANISATION.
WE ALSO CERTIFY THAT THEY ARE SAFE FOR THEIR INTENDED USE. [COPY OF INSPECTION REPORT TO BE ATTACHED]

SUBMITTED BY
DL ENGINEER

CHECKED BY
PRO. ENG/CON
MANAGER

MEP-MANAGER/ENGINEER

QA/QC-MANAGER/ENGINEER

Name:

Name:

Name:

Name:

Signature:

Signature:

Signature:

Signature:

WPFs RESPONSE
COMMENTS :

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