4172-GENON-1-25-0019 - Rev 1

PNP0017C
03/01/2021
CONTRACT TITLE: EPIC FOR CO2 WATER ALTERNATING GAS
(WAG) INJECTION PILOT PROJECT AT DUKHAN
CLIENT MAIN CONTRACTOR

CONTRACT NO : GC19108100 PROJECT NO: 4172
INSPECTION AND TEST PLAN FOR GROUTING WORKS.

Intervention Level
Control Procedure/ (H, W,A,R & S)
Item Activity Characteristics to be Verifying Record Responsibl
Reference Document, Acceptance criteria e Person
No Description verified and Format no Sub/ Contr
section no con actor
TPI QP
1 .0 GENERAL
1.1 Ensure latest  Approvals  Drawing and  Latest AFC Drawings /  AFC Document Construct H H R R
AFC Drawings Document Register Documents. files ion/
1 and Documents.  Relevance QA/QC
 Requirements
1.2 Verify  Review & verify  Manufacturer’s  Good working condition.  MME Register Construct H H R R
inspection, validity of calibration Catalog. (BMP19-F/01; ion/
1 measuring, test  Valid Calibration Certificate. QA/QC
equipment for certificates,  Procedure for Rev.0) /
suitability, Identification Monitoring and Calibration
accuracy, and number/Sticker. Report.
Validity of Measuring
Calibration.  Verify condition of the Equipment’s Doc:
test equipment. 4172-GENON-0-05-
0007.
1.3 Third-Party  Pre-Qualification  Project Specifications.  Approved PQD.  PQD Approval Construct H H R H
Testing Documents (PQD) ion/
1 Laboratory. QA/QC
Document No.4172-GENON-1-25-0019 Rev 1 Page 2 of 16



Intervention Level
TPI QP
1.4 Control of Non-  NCR shall be issued  Procedure for Control  Procedure for Control of  NCR & Construct H H S/ R
Conforming when a Non- of Nonconformity. Nonconformity- 4172-GENON- Response ion/QA/Q R
1 Products / C
Process. conformance product  Project Specifications. 0-05-0006. sheet-GF-4172-
noticed.  Approved MAR. QC-G-FM-0006.
 Approved MAR.
 CAR- GF-4172-
QC-G-FM-0008.
 Root Cause
Analysis GF-
4172-QC-G-FM-
0014.
2.0 Material Receiving Inspection:

2.1 Ensure  Materials Approval  Drawing and  Approved MAR.  Approved MAR Procure H H R R
Materials Document Register ment/Co
1 nstructio
submittals done
n/QA/QC
and Approvals.



Intervention Level
TPI QP
2.2 Ensure Material  Requirements of  Approved MAR  Compliance to Approved  RFI(GF-4172- Site
Receiving Approved MAR. MAR. QC-G-FM- Engineer/ H H W W/
 Project Specification,
Supervis R
Inspection  Requirements of QP Standards,  Compliance to Project 0001) or/
(MRIR) Project Specification. Contract, QCS 2014 Specification 4172-GENON-1-  MRIR(GF- Store In
& DEP 34.19.19.11- 4172-QC-G- charge/
14-0002, Clause 7.1
QA/QC.
Gen. FM-0005)
 Approved MAR
 MTC & DN.
3.0 Grouting Works:

3.1 Cement-based Non-Shrink Grout:
3.1.1 Surface  Mechanical /  Project Specification  Clearance from Mechanical.  RFI(GF-4172- Site H H W S/
preparation & Structure/equipment 4172-GENON-1-14- QC-G-FM-0001) Engineer/ R
1 Formwork  Surface preparation shall be in Suprs /
Preparation release 0002 accordance with  Grouting QA/QC
 Free of oil, grease,  General Notes for Civil manufacturer’s Checklist (GF-
paint, or loose Works recommendation. 4172-QC-FM-C-
materials  QCS 2014-Section-05,  Compliance to Project 0014).
 Base plates in Part-16 & Section-16, Specification 4172-GENON-1-  Release Note
contact with grout Part-08 14-0002, Clause 7.1 to 7.5 GF-4172-QC-G-
must be free of oil,  Galvanized Shim Plate. FM-004



Intervention Level
TPI QP
grease, dirt, or dust  Shell DEP  Chamfered as required.

pit. 34.19.19.11.  Soaking of concrete surface
 Laitance removed by  Manufacturer’s with water for min 24 hrs.
chipping. recommendation  Grout tightness of forms.
 Soaking of concrete  Approved MAR  Weep holes.
surface with water for
min 24 hrs.
 Weep holes
3.1.2 Grout Mixing,  Check grout material  Project Specification  Clearance from Mechanical.  RFI(GF-4172- Site H H W S/
Grout 4172-GENON-1-14- QC-G-FM-0001) Engineer/ R
1 Placement &  Duration of mixing  Mix preparation and pouring Suprs /
Grout Cube 0002 shall be as per manufacturer’s  Grout Pour card QA/QC
 Ambient and grout
Sampling.  General Notes for Civil recommendation. GF-4172-QC-
temperature.
Works.  Compliance to Project FM-C-0031.
 Method of placement
 QCS 2014-Section-05, Specification 4172-GENON-1-
 Duration of placement
Part-16 & Section-16, 14-0002, Clause 7.6.
 Weather condition Part-08.  Hot or cold weather
 Squeezing out of  Shell DEP procedures, as specified by the
grout from form 34.19.19.11. Manufacturer. shall be followed
 Cubes sampling. if grouting is to be done when



Intervention Level
TPI QP
 Flow of the grouting  Manufacturer’s ambient temperatures are not

shall be from one end recommendation between 5 °C and 32 °C for
to another end.  Approved MAR cement-based grout.
Pouring from all sides  Cubes shall be made in
is not permitted. accordance with ASTM
C109M. Cube size -50X50X50,
06 no’s total/ each day.
3.1.3 Compressive  Cube(50x50x50)  Project Specification  Cement-based non-shrink  Third Party Lab Lab H H W W/
Strength Test strength at 7 days 4172-GENON-1-14- grout- Minimum compressive Cube Crushing technicia R
1 n/
and 28 days 0002, Clause 7.6 strength shall be 40 N/mm2 at Test Report QA/QC
compressive strength.  ASTM C109/C109M. 28 days.
 Manufacturer’s
recommendation.
3.2 Epoxy-based Non-Shrink Grout for Rotating and Vibrating Machinery:

3.2.1 Epoxy Grout  Material Approval.  Project Specification  Clearance from Mechanical.  RFI(GF-4172- CM/Site H H H H
Mockup. 4172-GENON-1-14- QC-G-FM-0001) Engineer/
1  Requirements of  Compliance to Manufacturer’s Suprs /
manufacturer Data 0002, Clause 7.0. Product Data sheet.  Grouting QA/QC
sheet  Manufacturer’s Checklist (GF-
 Surface preparation. recommendation.



Intervention Level
TPI QP
 Method of application  Approved MAR.  Compliance to Project 4172-QC-FM-C-

as per manufacturer.  Approved Method Specification 4172-GENON-1- 0014).
 Clearance from statement. 14-0002, Clause 7.0.
mechanical.  Compliance to Approved
Method statement.
3.2.2 Surface  Mechanical /  Project Specification  Clearance from Mechanical.  RFI(GF-4172- Site H H W S/
preparation & Structure/equipment 4172-GENON-1-14- QC-G-FM-0001) Engineer/ R
1  Surface preparation shall be in Suprs /
Formwork release 0002 accordance to manufacturer’s  Grouting QA/QC
Preparation  Free of oil, grease,  General Notes for Civil recommendation. Checklist (GF-
paint, or loose Works  Compliance to Project 4172-QC-FM-C-
materials  QCS 2014-Section-05, Specification 4172-GENON-1- 0014).
 Base plates in Part-16 & Section-16, 14-0002, Clause 7.1 to 7.5  Release Note
contact with grout Part-08  Galvanized Shim Plate. GF-4172-QC-G-
must be free of oil,  Shell DEP FM-004
 Chamfered as required.
grease, dirt, or dust 34.19.19.11.
pit.  Surface shall be dry before
 Manufacturer’s application.
 Laitance removed by recommendation
chipping.  Grout tightness of forms.
 Approved MAR



Intervention Level
TPI QP
 Weep holes.  Weep holes.

3.2.3 Grout Mixing,  Check grout material  Project Specification  Clearance from Mechanical.  RFI(GF-4172- Site H H W S/
Grout 4172-GENON-1-14- QC-G-FM-0001) Engineer/ R
1
 Duration of mixing  Mix preparation and pouring Suprs /
Placement & 0002 shall be as per manufacturer’s  Grout Pour card QA/QC
 Ambient and grout
Grout Cube  General Notes for Civil recommendation. GF-4172-QC-
temperature.
Sampling. Works FM-C-0031.
 Method of placement  Compliance to Project
 QCS 2014-Section-05, Specification 4172-GENON-1-
 Duration of placement
Part-16 & Section-16, 14-0002, Clause 7.6
 Weather condition Part-08.  Hot or cold weather
 Squeezing out of  Shell DEP procedures, as specified by the
grout from form 34.19.19.11. Manufacturer shall be followed
 Cubes sampling.  Manufacturer’s if grouting is to be done when
 Flow of the grouting recommendation ambient temperatures are not
shall be from one end between 18 °C and 35 °C for
 Approved MAR
to another end. epoxy grout.
Pouring from all sides  Cubes shall be made in
is not permitted. accordance with ASTM C109M.
Cube size -50X50X50, 06 no’s



Intervention Level
TPI QP
 Epoxy grout sampling shall be

one sample for one batch
number.
3.2.4 Compressive  Cube(50x50x50)  Project Specification  Epoxy-based non-shrink grout  Third Party Lab Lab H H W W/
Strength Test strength at 7 days 4172-GENON-1-14- - Minimum compressive Cube Crushing technicia R
1 n/
and 28 days 0002, Clause 7.6 strength shall be 80 N/mm2 at Test Report QA/QC
compressive strength.  ASTM C109/C109M. 28 days.
 Manufacturer’s
recommendation.



Intervention Level
TPI QP
Interventions Levels Implementation criteria

Presence of intervention party is mandatory to proceed further. Activity cannot proceed, until and unless the intervention party confirm their
H Hold absence in advance. RFI to inspecting party is mandatory.
Presence of intervention party is required to proceed further. However, activity may proceed if intervention party do not attend for inspection at
W Witness the requested date and time. RFI to inspecting party is mandatory.
Intervention Party approval to the document is required. Document shall be formally submitted for Approvals.
A Approval
Intervention Party requires to review and acceptance of the documentation. Records shall be submitted for Review.
R Review
Interventions party shall monitor the ongoing sub-activities and process parameters compliance, in an effort to prevent rejections during stage
S Surveillance inspections / testing and resulting rework due to the same. RFI is not required.

Project/Contract No : GC19108100
PROJECT / CONTRACT TITLE : EPIC FOR CO2 WATER ALTERNATING GAS (WAG) INJECTION PILOT
PROJECT AT DUKHAN
REQUEST FOR INSPECTION

RFI Number Date Discipline System / Sub-system
4172-1-RFI-F-0001
Date of inspection Time of inspection Area/Unit/Location Drawing Number Rev.
Tag Number (As applicable) ITP / QCP No ITP Item No: Intervention Points
CONTRACT
SUB-CONT TPI QP
OR
Inspection Activity / Description:
Inspection item :
SUBMITTED BY CHECKED BY
FOR QUALITY CONTROL DEPT USE ONLY (as
CHECKED AND READY FOR INSPECTION
applicable)
SUB-CONTRACTOR CONTRACTOR
CONTRACTOR QA/QC TPI (as required)*
CONSTRUCTION CONSTRUCTION
Name
Contact Mobile No.
Signature
Date & Time
Contractor QA/QC shall complete the inspections and notify QP in case the work is “Not ready or Not Acceptable”, before the schedule
time. In such case, RFI shall be signed off by Contractor QA/QC with details and submit RFI copy to QP before COB, for info / Records.
INSPECTION RESULTS (Tick as applicable)

APPROVED  **APPD. WITH COMMENTS  CANCELLED  REJECTED 
1-Incomplete Work 2-Safety Issues 3-Test Crew not available
4-Test Equipment not available 5-Spec Violation 6-Unacceptable test Procedure /Result
7-Violation of ITP 8-Poor Workmanship 9-Material not as per data sheet / dwg
10-installation not as per the drawing 11- Weather conditions
12-Other (to be defined on a case-by-case basis )
** Date by which the below comments will be closed(To be identified before RFI sign off):
#NOTES  COMMENTS, If any COMMENTS

CLOSEOUT
:
SUB-CONTRACTOR /
INSPECTED BY: CONTRACTOR QC TPI QP
Contractor Construction
Name
Signature
Stamp / Staff No / Ref Ind::
RFI Closed on
#NOTES shall only provide any supporting information substantiating inspection results (approved /cancelled/rejected). COMMENTS shall detail
pending items required for RFI Approval. If the COMMENTS not closed and signed off by due date, RFI shall be considered as “REJECTED”.
Document No.4172-GENON-1-25-0019 Rev 1 GF-4172-QC-G-FM-0001, Rev

Page 11 of 16 2
MATERIAL INSPECTION REPORT
FORMAT NO: GF-4172-QC-G-FM-0005

CONTRACT No.: GC19108100
PROJECT CONTRACT TITLE: EPIC FOR CO2 WATER ALTERNATING GAS (WAG) INJECTION PILOT
PROJECT AT DUKHAN
CLIENT QATAR PETROLEUM
MIR No. 4172--MIR-CIVIL-000 DATE :
ITEM DESCRIPTION :
QUANTITY
DELIVERY NOTE / PACKING LIST
VENDOR / SUPPLIER
MANUFACTURER
ORIGIN
SPECIFICATION REF.
GALFAR QA/QC
Name Signature Date
TPI
Name Signature Date
ACCEPTED
REJECTED
COMMENTS, IF ANY
QATAR PETROLEUM
Name Signature Date

DETAILED MATERIAL INSPECTION REPORT
CONTRACT NO.: GC19108100 REPORT NO

PROJECT NO.: 4172 4172-MIR-CIVIL-0000
PROJECT : CONTRACT TITLE: EPIC FOR CO2 WATER DO No./ Date : DATE :
ALTERNATING GAS (WAG) INJECTION PILOT PROJECT AT DUKHAN
CLIENT : QATAR PETROLEUM
Manufacturer
Sl. Batch No./Heat Manufacturer/s STATUS
Material Description / Item Grade/Type Size Test Quantity Remarks
No No./Code.no upplier ACC / REJ
Certificate No.
Remarks:
GALFAR QA/QC TPI QATAR PETROLEUM
Name
Designation
Sign & Stamp
Date
GF-4172-QC-G-FM-0005

GROUTING WORK INSPECTION RECORD
PROJECT :CONTRACT TITLE: EPIC FOR CO2 WATER ALTERNATING GAS (WAG) INJECTION PILOT PROJECT AT DUKHAN
CONTRACT REF. :GC19108100
PROJECT NO.:4172
LOCATION : RFI NO. :
DRAWING REF : AREA :
DESCRIPTION :
ITEM # ACTIVITY RESULT
1 Mechanical QA/QC clearance prior to grouting
2 Surface preparation, cleaning and chipping are done
3 Inspection of surface to receive grout
4 Inspection of Surface saturated prior to grouting
5 Inspection of grout material and mixing water & ice are sufficient and available in site
6 Inspection of grout mixing operation
7 Inspection of form work, chamfers and thickness of grout to receive
8 Inspection of grout placement
9 Inspection and witness of cube samples taken for compressive strength test
10 Inspection of protection of grouted area immediately after pouring.
Remarks:
GALFAR
ACCEPTANCE GALFAR QA/QC TPI(If Applicable) QATAR PETROLEUM
CONSTRUCTION
NAME
SIGNATURE
DATE
GF-4172-QC-FM-C-0014

GROUT POUR CARD
PROJECT : EPIC FOR CO2 WATER ALTERNATING GAS (WAG) INJECTION PILOT PROJECT AT DUKHAN
DRAWING REF : DATE:
DESCRIPTION:
Consturction department records QC department records
Cum. QTY. Cu Grout sample

Location Time batch Time start Time finish QTY. Cu. M Time sampled Air temp. Grout Temp. Remarks
M cube ID No
ACCEPTANCE GALFAR CONSTRUCTION GALFAR QA/QC TPI(If Applicable) QATAR PETROLEUM
NAME
SIGNATURE
DATE
GF-4172-QC-FM-C-0031
INTER DISCIPLINE RELEASE NOTE
PROJECT :CONTRACT TITLE: EPIC FOR CO2 WATER ALTERNATING GAS (WAG) INJECTION PILOT PROJECT AT DUKHAN
PROJECT NO.:4172
DRAWING REF : AREA :
DESCRIPTION :
Activity Description,Location and Release Release From Release TO Discipline

Discipline QA/QC Qatar Petroleum
For ) (DISCIPLINE) (DISCIPLINE) Engineer
Activity Description:
Location :
Release for:
Remarks:
GALFAR
ACCEPTED DISCIPLINE GALFAR QA/QC QATAR PETROLEUM
CONSTRUCTION
NAME
SIGNATURE
DATE
GF-4172-QC-G-FM-004

4172-GENON-1-25-0019 - Rev 1

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PNP0017C

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

Document No.4172-GENON-1-25-0019 Rev 1 Page 2 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

2.0 Material Receiving Inspection:

Document No.4172-GENON-1-25-0019 Rev 1 Page 3 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

3.0 Grouting Works:

Document No.4172-GENON-1-25-0019 Rev 1 Page 4 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

grease, dirt, or dust  Shell DEP  Chamfered as required.

Document No.4172-GENON-1-25-0019 Rev 1 Page 5 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

 Flow of the grouting  Manufacturer’s ambient temperatures are not

3.2 Epoxy-based Non-Shrink Grout for Rotating and Vibrating Machinery:

Document No.4172-GENON-1-25-0019 Rev 1 Page 6 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

 Method of application  Approved MAR.  Compliance to Project 4172-QC-FM-C-

Document No.4172-GENON-1-25-0019 Rev 1 Page 7 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

 Weep holes.  Weep holes.

Document No.4172-GENON-1-25-0019 Rev 1 Page 8 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

 Epoxy grout sampling shall be

Document No.4172-GENON-1-25-0019 Rev 1 Page 9 of 16

CLIENT MAIN CONTRACTOR

INSPECTION AND TEST PLAN FOR GROUTING WORKS.

Interventions Levels Implementation criteria

Document No.4172-GENON-1-25-0019 Rev 1 Page 10 of 16

REQUEST FOR INSPECTION

Date of inspection Time of inspection Area/Unit/Location Drawing Number Rev.

Inspection Activity / Description:

Date & Time

INSPECTION RESULTS (Tick as applicable)

#NOTES  COMMENTS, If any COMMENTS

Document No.4172-GENON-1-25-0019 Rev 1 GF-4172-QC-G-FM-0001, Rev

FORMAT NO: GF-4172-QC-G-FM-0005

CLIENT QATAR PETROLEUM

MIR No. 4172--MIR-CIVIL-000 DATE :

DELIVERY NOTE / PACKING LIST

Document No.4172-GENON-1-25-0019 Rev 1 Page 12 of 16

CONTRACT NO.: GC19108100 REPORT NO

CLIENT : QATAR PETROLEUM

GALFAR QA/QC TPI QATAR PETROLEUM

Sign & Stamp

Document No.4172-GENON-1-25-0019 Rev 1 Page 13 of 16

CONTRACT REF. :GC19108100

LOCATION : RFI NO. :

DRAWING REF : AREA :

ITEM # ACTIVITY RESULT

1 Mechanical QA/QC clearance prior to grouting

2 Surface preparation, cleaning and chipping are done

3 Inspection of surface to receive grout

4 Inspection of Surface saturated prior to grouting

6 Inspection of grout mixing operation