Release Note N°: RN210607060E

Page N°: 1/ 3

RELEASE NOTE
Boss Order No.: 5030091 DATE: 07.06.2021

Name & Address of the Client : M/s. Hindustan Petroleum Corporation Ltd., Mumbai Refinery.
BD Patil Marg, Old Corridor Road, Chembur, Mumbai - 400074,
Maharashtra (INDIA)

Name of the Project : N/A

Name & Address of the Seller
Contract / Order No. & Date
Date (s) &Place (s) of Inspection
: M/s. Rahul Forge & Pipe Fittings
Plot No. 90-A, Lakdi Bunder, Reay Road, Mumbai – 400010.
Maharashtra (INDIA)
: 20-93956 Dtd.25.03.2021
: On 02.06.21 to 04.06.21 at Manufacturer’s place in Usatane & Kalamboli.

Description of the Material : Forged Flanges.

PO Item Description Qty on Qty Qty Qty Qty Balance

Item Order Previously Offered Now Rejected (Nos.)
No. (Nos.) Passed (Nos.) Passed (Nos.)
(Nos.) (Nos.)

Concentric Reducer, CS, SMLS,

40 6”X4” NB X Sch 40, A234 WPB, BW. 30 NIL 29 29 NIL 01
Lot No.: RF-642

90 Deg Elbow, CS,

1.5” NB X 3000#, ASTM A105, SW,
115 200 NIL 48 48 NIL 152
ANSI B16.11.
Lot No.: RF-112F

45 Deg Elbow, CS,

1” NB X 3000#, ASTM A105, SW,
164 50 NIL 18 18 NIL 32
ANSI B16.11.
Lot No.: RF-112F

P.O. Status: Balance

Form VF-IN-IND-IN-016 Ver: 1.1 /14.11.2020

This document is issued by the Company subject to its General Conditions of Service
(www.sgs.com/en/Terms-and-Conditions.aspx). Attention is drawn to the limitations of liability,
SGS India Pvt. Ltd indemnification and jurisdictional issues established therein.
This document is to be treated as an original within the meaning of UCP 600. Any holder of this
NITCO Biz Park, 5th Floor, Road No. 16, document is advised that information contained hereon reflects the Company’s findings at the
Wagle Industrial Estate (MIDC), time of its intervention only and within the limits of client’s instructions, if any. The Company’s
Thane (West) - 400604 sole responsibility is to its Client and this document does not exonerate parties to a transaction
from exercising all their rights and obligations under the transaction documents. Any
Maharashtra, India unauthorized alteration, forgery or falsification of the content or appearance of this document is
Phone: +91 22 49170100 / 300 unlawful and offenders may be prosecuted to the fullest extent of the law.
Fax: +91 22 49170347 The authenticity of this document may be verified at
https://sgsonsite.sgs.com/en/v2/common/ecertificate/authenticateeCertificate.jsp.
Release Note N°: RN210607060E
Page N°: 2/ 3

Boss Order No.: 5030091 DATE: 07.06.2021

Reference Document No.

(Spec./ Standard / Code Scope of Inspection
Observation/Results
/Drawing / Sampling Standard / (Checks / Tests - Witnessed & Reviewed)
Any Other)

1) Reviewed Raw Material Test Certificate.

PO No. & Date:
20-93956 Dtd.25.03.2021 2) Reviewed Lab Test Reports for Final Product
Chemical & Mechanical Properties.
QAP / ITP No: QAP NO :
INSP/QAP – 052 Rev.0 3) Reviewed Heat Treatment Chart (Normalizing &
Dtd.06.09.2016 Tempering) for Final Product.
Approved By HPCL
4) Randomly Witnessed Hardness Test (10%).

5) Visual Inspection (10%).

Satisfactory
Approved Drawing No.: NA
6) Witnessed Dimensions Check (10%).
Reference standard / code /
7) Review of Final Documentation.
specification & Edition /
Version / Year : ASTM A234,
A105, ASME B16.9, B16.11
Sampling Standard & Edition
/ Version / Year.
As per Approved SQAP

This document is issued by the Company subject to its General Conditions of Service
(www.sgs.com/en/Terms-and-Conditions.aspx). Attention is drawn to the limitations of liability,
SGS India Pvt. Ltd indemnification and jurisdictional issues established therein.
This document is to be treated as an original within the meaning of UCP 600. Any holder of this
NITCO Biz Park, 5th Floor, Road No. 16, document is advised that information contained hereon reflects the Company’s findings at the
Wagle Industrial Estate (MIDC), time of its intervention only and within the limits of client’s instructions, if any. The Company’s
Thane (West) - 400604 sole responsibility is to its Client and this document does not exonerate parties to a transaction
from exercising all their rights and obligations under the transaction documents. Any
Maharashtra, India unauthorized alteration, forgery or falsification of the content or appearance of this document is
Phone: +91 22 49170100 / 300 unlawful and offenders may be prosecuted to the fullest extent of the law.
Fax: +91 22 49170347 The authenticity of this document may be verified at
https://sgsonsite.sgs.com/en/v2/common/ecertificate/authenticateeCertificate.jsp.
 Release Note N°: RN210607060E
Page N°: 3/ 3

Identification: Hard stamping marking observed on fittings as Mfr Logo, OD, Schedule, MOC, Heat No.
Remarks: This is a Final Inspection Report. Inspected Quantity is Passed & Cleared for dispatch.
Deviation accepted: NIL

Inspection Location of Identification Inspected By Signature of SGS

Identification Representative

SGS Metal Punch made Double on

witnessed & single on rest of the Mr. Pritam Pawar
MU06 items near marking.
OR

MU28
The information stated in this release note is derived from the results of inspection or testing procedures carried out in accordance with the
instructions of our clients, and / or our assessment of such results on the basis of any technical standards, trade custom or practice, or other
circumstances which should in our professional opinion be taken into account.
“In accordance with Client’s instructions, the Company’s involvement has been limited to witnessing/observing a third party’s intervention(s) at the
third party’s laboratory/test house or other facilities and installations used for the intervention(s). The Company’s sole responsibility was to be
present at the time of the third party’s intervention(s) to forward the results, or confirm the occurrence, of the intervention(s). The Company is not
responsible for the condition or calibration of apparatus, instruments and measuring devices used, the analysis methods applied the qualifications,
actions or omissions of the third party’s personnel or the analysis results.
This document is issued by the Company under its General Conditions of Service accessible at http://www.sgs.com/terms_and_conditions.htm.
Attention is drawn to the limitation of liability, indemnification and jurisdiction issues defined therein. Any holder of this document is advised that
information contained hereon reflects the Company’s findings at the time of it’s intervention only and within the limits of Client’s instructions, if
any. The Company’s sole responsibility is to its client and this documents does not exonerate parties to a transaction from exercising all their rights
and obligations under the transaction document. Any unauthorized alteration, forgery or falsification of the content or appearance of this document
is unlawful and offenders may be prosecuted to the fullest extent of the law”.
This inspection has been carried out to the best of our knowledge & our responsibility is limited to the exercise of reasonable care. This Release /
Discrepancy Note reflects our findings at the time & place of inspection and is not intended to relieve the seller from their contractual obligations

Form VF-IN-IND-IN-016 Ver: 1.1 /14.11.2020

for SGS India Private Limited

This document is issued by the Company subject to its General Conditions of Service
(www.sgs.com/en/Terms-and-Conditions.aspx). Attention is drawn to the limitations of liability,
SGS India Pvt. Ltd indemnification and jurisdictional issues established therein.
This document is to be treated as an original within the meaning of UCP 600. Any holder of this
NITCO Biz Park, 5th Floor, Road No. 16, document is advised that information contained hereon reflects the Company’s findings at the
Wagle Industrial Estate (MIDC), time of its intervention only and within the limits of client’s instructions, if any. The Company’s
Thane (West) - 400604 sole responsibility is to its Client and this document does not exonerate parties to a transaction
from exercising all their rights and obligations under the transaction documents. Any
Maharashtra, India unauthorized alteration, forgery or falsification of the content or appearance of this document is
Phone: +91 22 49170100 / 300 unlawful and offenders may be prosecuted to the fullest extent of the law.
Fax: +91 22 49170347 The authenticity of this document may be verified at
https://sgsonsite.sgs.com/en/v2/common/ecertificate/authenticateeCertificate.jsp.