Item Code Quantity Description Tag No., Batch No.

,
Serial No., Cast,
Heat No.
Witnessed Burst Test for Cylinders
1 M 34665
(Batch No. LPG/48 L/3389 - SR.No: — M 34539 to M 34740
Witnessed Burst Test for Cylinders
1 M 34955
(Batch No. LPG/48 L/3390 - SR.No: — M 34741 to M 35143
Witnessed Burst Test for Cylinders
1 M 35398
(Batch No. LPG/48 L/3391 - SR.No: — M 35144 to M 35546
--
Witnessed Burst Test for Cylinders
1 M 35744
(Batch No. LPG/48 L/3392 - SR.No: — M 35547 to M 35949
Witnessed Burst Test for Cylinders
1 A 40022
(Batch No. LPG/108 L/012 - SR.No: — A 39960 to A 40060
Witnessed Burst Test for Cylinders
1 52575
(Batch No. LPG/54 L/129 - SR.No: — M 52350 to M 52862
RESULTS OF Accepted Not Compliant ORDER STATUS: Complete Incomplete
INSPECTION:
1.0 SUMMARY:
Inspection visit was made at Haifa Industrial Services Co LLC. Workshop, Rusayl to witness Burst Tests as per the Client’s
request.

Please refer Page 02 for more details about inspection.

ATTACHMENTS: NCR Punchlist Partial Release Balance Release Full PO Release

RECORD OF HOURS

2.0 PERSONS PRESENT:

3.0 DOCUMENTATION USED / APPROVAL STATUS:
 OS 120:1986
 GSO ISO 22991:2008
4.0 INSPECTION CARRIED OUT (reference ITP clause if applicable):
 Witnessed Burst Test for the below mentioned cylinders with Achieved Result :-
Cylinder Burst Standard
Capacity Serial No. Pressure
(Liter) Achieved
L5-FMT-046 Rev. 03
 1.Report Headings: 2.Persons Present 3.Documentation Used /Approval Status 4.Inspection Carried Out 5.HSE Feedback
on the Vendor 6.Results/Conclusions 7.Overall Order Status 8.Next Visit/Exit Call 9.Attachments/Photos

(Bar)
48 M 34665 76.62 OS 120:1986
48 M 34955 78.12 OS 120:1986
48 M 35398 77.62 OS 120:1986
48 M 35744 82.12 OS 120:1986
108 A 40022 81.12 GSO ISO 22991:2008
54 52575 89.12 GSO ISO 22991:2008
 Burst test pressure value for above all meets the standard requirements - Found accepted.
 Verified & Reviewed calibration certificate of pressure gauge – Found valid.

 CALIBRATION OF INSTRUMENTATION USED:

Type of Equipment Manufacturer Serial N° Date Last Current Calibration Calibration

Calibrated Expiry Date Certificate N°
Pressure Gauge WIKA 150856383 23/04/2018 23/04/2019 --

5.0 HSE FEEDBACK ON VENDOR: General HSE is followed by the client.

6.0 RESULTS / CONCLUSIONS: Satisfactory.

7.0 OVERALL ORDER STATUS: Ongoing.

DELIVERY:
PO Delivery Date Current Scheduled Delivery Delivery Point Comments
N.A N.A N.A N.A

8.0 NEXT VISIT / EXIT CALL (must give estimated date if no fixed date; include stage/activity details): TBA.

- End of Report –

L5-FMT-046 Rev. 03