M.

AL-BARGHASH AL-MANSOURI & SONS TRADING & CONTRACTING CO.

Department Activity/Process:
Department Head/Process Owner:
Project Contract & PO No: OMPP/6600042388 - 6510926506
Finding raised during:
Audit
Follow-up Audit
✘ Surveillance
Originator:
ISO 9001:2015 (Quality Management System)
INTERNAL NON-CONFORMANCE / CORRECTIVE ACTION REPORT
UTMN-3101 gas well Report No: NCR-MPSA4-C- Revision No:
Sivakumar Thangavel - Project Engineer- Head Date: November 7, 2022
BI/JO No: 11-19000-9812
MBTC Procedure Reference: Procedure Section:
Project Procedure Reference: SAES-l-450 Procedure Section: Sec. 14.10.3d)
ACD: Dec-07-2022
Noted by:
Cris Gines - QC Civil Ram Kumar - QC Supervisor
Name/Signature/Date Name/Signature/Date

Section A: DESCRIPTION OF FINDING

During site inspection at UTMN-3101 gas well, 8"flowline was lowered at KM 0+700 to KM 1+300 but surveying sticks were not provided which is a non-conformance
to SAES-L-450 Section 14.10.3d) "After lowering the pipe into the trench, the Contractor shall use surveying sticks to establish dimensional controls to satisfy the
inspector that the final cover will be sufficient and centered over the pipeline."

Acknowledged By: Signed: Date:

(HOD/Process Owner) - Project Engineer

Section B: CORRECTION/IMMEDIATE ACTION

Section C: ROOT CAUSE ANALYSIS (Conditions or fundamental causes leading to the identified non-conformity)

Responsible Person: Signed: Date:

Section D: CORRECTIVE ACTION (Elimination of Root Cause)

Responsible Person: Signed: Date:

Verification of Effectiveness of Corrective Action

Status Tick: Date:
1. Corrective Action Verified
2. Re-Inspection Required/Surveillance Necessary
3. Closed; Corrective Action Implemented Satisfactorily
Acknowledged By: Signed: Date:
(HOD/Process Owner)
Acknowledged By: Signed: Date:
(QA/QC Department)
Acknowledged By: Signed: Date:
(SAPID)

QAC-4-018, Rev.4 1 of 2
 M. AL-BARGHASH AL-MANSOURI & SONS TRADING & CONTRACTING CO.
ISO 9001:2015 (Quality Management System)
INTERNAL NON-CONFORMANCE / CORRECTIVE ACTION REPORT
Department Activity/Process: UTMN-3101 gas well Report No: NCR-MPSA4-C- Revision No:
Department Head/Process Owner: Sivakumar Thangavel - Project Engineer- Head Date: November 7, 2022
Project Contract & PO No: OMPP/6600042388 - 6510926506 BI/JO No: 11-19000-9812
Note: Copy of iNCR to be Submitted to SAPMT/PID within 48 hrs. of issuance.

QAC-4-018, Rev.4 2 of 2