Adssc Form

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STANDARD OPERATING FORM

Form No. Version No.

SOF-1301-H 000 1 of 1

PAC PROCESS FORM-HANDING OVER FORM-1 SITE INSPECTION REPORT PRIOR TO PAC

Page

Contact No.:
Consultant: Inspection No: Pipe Diameter (mm): From Manhole/ I.C.:

O-2536

Location:
Contractor: Date: Material: To Manhole/ I.C.: CL: IL: GL: Depth:

DORSCH GRUPPE

MACE

Manhole/ I.C. No:


Type of Manhole Material:

Description Cover & Frame Sealing Plate Liner/T Lock/Epoxy Adjustment Ring Shaft Unit Base Unit Ladder/Safety Cage/Chain Back Drop Future Port

Concrete with both sides GRP Liner Concrete with insides GRP Liner Concrete with epoxy inside and outside with protection material Type of Material O.K. Not O.K. Remarks Heavy Duty D.I.400 GRP GRP Concrete with both sides GRP Concrete with both sides GRP Concrete with both sides GRP N/A GRP Average Dept: Gradient: GRP UPVC PVC HDPE DI CI Concrete surrounds Aggregate surround Excavated material Allowable: Allowable: Not O.K. Remarks

Pipe Line Length:


Pipe Material: Encasement of Pipe: Stiffness (N/M2) Initial Deflection: Final Deflection: CCTV Inspection: Description Straightness Leaks/ Salinity Flow Test General Condition RC

AC

Within Llimits Within Limits O.K.

Manhole/ I.C. No:


IL: General Notes:

CL:

GL: Depth:

Name CONTRACTOR CONSULTANT O&M ADSSC

Signature

Date

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