EPM-ITP-PC-

Doc No
SAFCO/IBB MOBILE COATING 001
UNIT PROJECT Rev. No. 00
ITP FOR GAVEL SURFACING AND DUST
Date 25th Jun, 2020
PREVENTION
Page 1 of 6

NATIONAL CHEMICAL FERTILIZER COMPANY

IBB MCUP & MODIFICATION OF K-12 BUILDING

PROJECT NO. : SP-173100119

INSPECTION AND TEST PLAN

FOR
GRAVEL SURFACING AND DUST PREVENTION

A 25 Jun, 2020 Issue for Approval MSH NCC

Rev
Date Description Original By Checked By Approved By Checked By Approved By
.

No Part of this document or the information it contains may be reproduced or transmitted in any
form or by any means electronic or mechanical, including photocopying, recording, or by any
information storage and retrieval system, without permission in writing from SABIC or NCC
 EPM-ITP-PC-
Doc No
SAFCO/IBB MOBILE COATING 001
UNIT PROJECT Rev. No. 02
ITP FOR GAVEL SURFACING AND DUST
Date 25th Jun, 2020
PREVENTION
Page 2 of 8

TABLE OF CONTENTS

1.0 ITP for Gravel Surfacing And Dust Prevention..........................................................................3

2.0 Checklist- Gravel Surfacing And Dust Prevention.....................................................................5

3.0 Checklist-Backfill / Compaction ..................................................................................................6

4.0 Checklist-Final Acceptance For Gravel Surfacing And Dust Prevention.................................7

 Doc No EPM-ITP-PC-001

SAFCO/IBB MOBILE COATING UNIT PROJECT Rev. No. 00

ITP FOR GAVEL SURFACING AND DUST PREVENTION Date 25th Jun, 2020
Page 3 of 6

Print Name Signature Name of Doc No: EPM-ITP-PC-001

INSPECTION AND TEST PLAN (ITP) FOR COMPANY
Prepared By: (1) Georgy Mathew MSH Revision: 00
(Gravel Surfacing And Dust Prevention ) Approved By: (2) Date: 25 Jun,2020
COMPANY App: Page:
Discipline: Civil PROJECT: IBB MCUP & MODIFICATION OF K-12 BUILDING
Inspection Level :
Location: (3) IBB/SAFCO
Table No:
Criticality Level : Item Name (3): Tag No (3):

Inspection Responsibility
Sr. Acceptance Verifying Sub-
Inspection Activity Characteristics Verified (4) Reference Document (5)
No Criteria (6) Document (7) Contractor CONTRACTOR COMPANY
/Vendor

Third Party Reports

1 Material Approval Material Approved Document Approved Document SES-C01-F01-02 H R
Vendor Approval
2 Sub grade Preparation

As per inspection items SES C02-S02 SES C02-S02

2.1 Leveling/slopping and Compaction CV-004-1 H W
in the Checklist of QVD IFC DRAWING IFC DRAWING

As per inspection items SES C02-S01, SES-C02- SES C02-S01, SES- CV-004-2
2.2 Sub-grade/compaction/FDT H R
in the Checklist of QVD S02 C02-S02 Third Party Report

3 Surfacing
As per inspection items IFC Drawing IFC Drawing
3.1 Gravel Laying/Thickness CV-004-1 H W
in the Checklist of QVD SES-C02-F02 SES-C02-F02
SES-C02-F02 SES-C02-F02
As per inspection items
4 Final Acceptance SES C02-S02 SES C02-S02 CV-004-3 H H
in the Checklist of QVD
IFC DRAWING IFC DRAWING

Legend:
(1) ‘Prepared by’ should be the name, signature and COMPANY’s name for the Vendor’s/Sub-Contractor’s representative.
 Doc No EPM-ITP-PC-001

SAFCO/IBB MOBILE COATING UNIT PROJECT Rev. No. 00

ITP FOR GAVEL SURFACING AND DUST PREVENTION Date 25th Jun, 2020
Page 3 of 6

(2) ‘Approved by’ should be the name, signature and COMPANY’s name for the CONTRACTOR’s representative.
(3) ‘Location’, ‘Item Name’ and ‘Tag Number’ shall be used if applicable.
(4) ‘Characteristics Verified’ are the parameters checked during the inspection activity.
(5) ‘Reference Document’ is the Project Specification / Code / Standard / Drawing, Procedure etc. on the basis of which inspection shall be conducted.
(6) ‘Acceptance Criteria’ is the tolerance, reading, value or an outcome derived from reference documents.
(7) ‘Verifying Document’ is the record generated during inspection & Testing using approved forms / checklists.
(8) ‘Inspection Responsibility’ is the role of Vendor / Sub-Contractor, CONTRACTOR and COMPANY for each inspection step. Inspection responsibility shall be ‘I’ for Inspection, ‘R’ for review, ‘A’ for approval, ‘S’ for
Surveillance, “W’ for 100% Witness, ‘SW’ for random witness and ‘H’ for hold.
 EPM-ITP-PC-
Doc No
SAFCO/IBB MOBILE COATING 001
UNIT PROJECT Rev. No. 00
ITP FOR GAVEL SURFACING AND DUST
Date 25th Jun, 2020
PREVENTION
Page 4 of 6

CV-004-1
GRAVEL SURFACING AND DUST PREVENTION CHECK Record
LIST No
Date

Project No SP-173100119 Area No

Location Drawing
Description IBB/SAFCO No.

Test Reports

Sub Cont NCC

Item Description of Check
Accept Reject Accept Reject
01 Contractors QC protocol is existing
02 Material is from approved source
03 Material type and size as per specification
04 Sub grade leveling, Compaction is as per specification
05 Grade is sloped towards drain points
06 Field density and moisture content recorded for grade
Laying of material ( layer thickness, limit elevation, grade)
07
as per Design Drawing,
08 Appearance is acceptable
Top layer of gravel surface chocked with fine gravel to
09
stabilize for walking

Note:

Subcontractor NCC E&PM

Company

Name

Signature

Date
 EPM-ITP-PC-
Doc No
SAFCO/IBB MOBILE COATING 001
UNIT PROJECT Rev. No. 00
ITP FOR GAVEL SURFACING AND DUST
Date 25th Jun, 2020
PREVENTION
Page 4 of 6
CV-004-2
Record.N
BACKFILL/COMPACTION CHECKLIST o
Date
Project No SP-173100119 Area No.
Material Type Drawing No.
Compaction Equipment Optimum Moisture
Field Test Equipment Proctor Density
Location IBB/SAFCO
Description
Examination Items Result Examination Items Result
Keep cleaning without water,  Satisfied  Satisfied
roots, trash, other foreign  Unsatisfied Fill material test Reports filed  Unsatisfied
materials  N/A
 Satisfied  Satisfied
Coating protection applied  Unsatisfied Properly moistened before placing  Unsatisfied
properly  N/A  N/A
 Satisfied
Material comply with ≧90%
 Unsatisfied Compacted Density
specification ≧95%
 N/A
Bottom Bed/Backfill Depth mm Total Layer of Compaction
Layer Density Test (Points)
Layer Thick 1st 2nd 3rd 4th 5th 6th 7th 8th 9th
Report No. Result
No. (mm) Densit Density Density Density Density Density Density Density Density
y
 Sat.
1  Unsat.
 Sat.
2  Unsat.
 Sat.
3  Unsat.
 Sat.
4  Unsat.
 Sat.
5  Unsat.
 Sat.
6  Unsat.
 Sat.
7  Unsat.
 Sat.
8  Unsat.
 Sat.
9  Unsat.
 Sat.
10  Unsat.
Subcontractor NCC E&PM
Company
Name
Signature
Date
 EPM-ITP-PC-
Doc No
SAFCO/IBB MOBILE COATING 001
UNIT PROJECT Rev. No. 00
ITP FOR GAVEL SURFACING AND DUST
Date 25th Jun, 2020
PREVENTION
Page 4 of 6

CV-004-3
FINAL ACCEPTANCE FOR GRAVEL Record
SURFACING AND DUST PREVENTION No
Date
Project No SP-173100119 Area No
Location Drawing
Description IBB/SAFCO No.
Subcontractor NCC
Description of Check
Accept Reject Accept Reject
1. Gavel Finish as per requirement

2. Compaction checked

3. Thickness of Gravel is correct

4. Appearance is acceptable

Comments:　

Subcontractor NCC E&PM

Name

Signature

Date