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Saudi Industrial Inspection Services Co. Ltd

Report No. 2024-011-1801-10591-IC-007 Certificate of Thorough Examination and / or Date: 30-Jan-2024

Test For Equipment Inspection Appliance

Al Salem Johnson
Client Name Job Order No. 2024-011-0102-10713
Controls
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Client Address Purchase Order No. ---

Qi/TUV Branch Office Riyadh Report Valid Until 29-Jan-2025

Inspection Location Dubai - Free Zone Inspection Date 30-Jan-2024

Manufacturer’s Name Bell & Gossett -Xylem brand Sticker No.

Model VSX-VSCS / 5X6X13.5B Serial No. 004592-01-01
Motive Power DC / AC Identification No. VSX00000063710
Capacity / Head 1343 GPM / 138 FT Year of Built NA
Date of Last Thorough
01/30/2024 Type of Inspection Visual & functional
Examination
ID No. QTY Description
VSX00000063710 1 Chilled water pump
Applicable Standard ANSI/AHRI Standard 550/590 (I-P)

Is this the first examination after installation Was the thorough examination carried out:
Yes No
Or assembly at a new site of location:
*Within an interval of 3 months? Yes No
If the answer to the above question is YES.
Yes No *Within an interval of 6 months? Yes No
Has the equipment been installed correctly?
Identification of any part found to have a defect which is or could *Within an interval of 12 months? Yes No
become a danger to person and a description of the defect (if *In accordance with an examination scheme? Yes No
none state none)
*After the occurrence of exceptional
Yes No
circumstances?
Remarks: Any defects noted and alteration or repairs required before Above Description Is put into service. (if none enter “none”).

Is the above a defect which is of immediate danger to persons? No Yes

Is the above a defect which is not yet become a danger to persons? (if yes state the day by when) No Yes
Particulars of any repair, renewal or alteration Inspected By Company Stamp
required to remedy the defect identified
ALIZAR MEHBOOB THAKUR
above
Reviewed / Approved by : MAHMOUD
Particulars of any tests carried out as part of
Is this equipment safe to operate?
the examination (if none state none):
Next Inspection 01/29/2025
Yes (Accept) No (Reject)

This Inspection Certificate shall not be reproduced Except In Full, Without the Written Approval of Saudi Industrial Inspection Co. Ltd. – Qi/TUV Austria.
Inspection Results Relate Only to The Inspected Items and the liability for the samples through the inspection period only.
This certificate concerns the samples that have been inspected only. This certificate is null and void in the event of any alteration or modification,
deletion or addition.
The Client has Right during a maximum period of fifteen days from the date of issuance of this certificate; let us know in writing for any error that may
take place in this certificate, also has Right to Recover Samples That Have Been Tested or remained

Saudi Industrial Inspection Services Company. – Qi/TUV Austria Membership No.: 70722 C.R No.: 1010412237
Motabaqah Building - Saudi Specialized Laboratories Co, Full Paid Capital: 10,000,000 SAR Limited Liability Co.
King Abdul Aziz Seaport, Dammam 32211 Saudi Arabia
Tele: +966 13 814 7381
Fax: +966 13 814 7384
www.tuvam.ae