QR-4000-02

SMALL PROJECTS GROUP QUALITY RECORD MAINTENANCE SERVICE

RECORD NO. : SI / PO Number :

SYSTEM NO. : OPEN DITCH Client :

ITEM :

PCWBS : LOCATION :

FWBS : DRAWING NO. :

PRE POUR ACTIVITY

REQUIRED DATE QC INSPECTOR
ITEM
YES NO COMPLETED CONTRACTOR MCL - SPG MCL - Client
EARTH WORK
EXCAVATION
LEVELING AND COMPACTION

CONCRETE WORKS : CAST IN PLACE (U-DITCH)

LEAN CONCRETE
CAST IN PLACE (U-DITCH)
SUNDRIES/COVER INSTALLED

CONCRETE WORKS : LINING (V-DITCH)

POLYETHELENE SHEET LINING
FORMING
WIRE MESH PLACING
CONCRETE POURING
FINISHING
POUR ACTIVITY
POUR DATE : SUPPLIER :
WEATHER : AMBIENT TEMPERATURE :
SLUMP : CONCRETE TEMPERATURE :
ADDITIVE : AIR CONTENT :
TEST SPECIMEN No. : QUANTITY SPECIMEN REQ'D :
POUR TERMINATED : AMB. TEMP. DURING CURE :
REASON :
CONCRETE DESIGN MIX :
ATTACH COPY OF CONCRETE SUPPLIER BATCH TICKETS TO THIS FORM
REMARKS :

CONTRACTOR : --------------
DATE :

COMPANY : MCL -SPG

DATE :

CLIENT : MCL -Client

DATE :