Doc.

No FORM-04-QA-C036
Inspection Form Doc. Status For Project
Revision 00
Date 11-Apr-18
Inspection Form Steel Pipe
Page 1 of 1

PROJECT/ PT : Regis tration No.:

LOCATION : Day / Date :
CONTRACT NO. : Location :
CONTRACTOR :

Unit = mm
B

T1

L
T4 T2

T3

Note : The tip measurement (a, c) is made at least 50 mm f rom the edge
MATERIAL SPESIFICATION Minimum sample size is 10% of each size

Merk : ......................................
Type : Baja Carbon Galvanis Stainles s HDPE PVC .............

Seam les s ERW

Rating : PN 10 PN 25
PN 16 PN 30

PN 20 ............

Schedule : SCH. 80 SCH. 10

SCH. 40 ..............

Material : ASTM A 106 gr.B ASTM A 53 gr.A ........

Size : Ø .........................
Tools : Thicknes s tes ter Caliper Meteran ............

Factory Brand Gunung Garuda Krakatau Steel .............

Sample No. No : ......... No : ......... No : ......... No : ......... No : ......... No : ......... No : .........
T1
T2
A
T3
T4
T1
T2
Thick of Pipe B
T3
T4
T1
T2
C
T3
T4
A
Diameter B
C

Length ( mm ) L

Inspeksi Visual Good : .................... Damage : ................ ........................

Received Not Received ...........................

Mill Certificate
Mill Certificate No : Heat No :
Toleransi : L = ±………(mm) D = ±…....(mm) t = ±…....(mm)

Rejected Accepted

Contractor Owner
PT. ………………………………………… PT. ………………………………………………………..
Site Engineer Site Manager Construction Assistant Construction Manager

(………………………) (………………………) (………………………) (………………………)