Client Reference: 19/100/HI/YS/TI Assign No.

: ---- Report No: 19

Client Contact: Mr.Jithesh SO No.: ------ Date of Visit: 29.04.2019

Work Order No.: TPL-2019-002 Vendor Ref.: ------ Next Visit Date: TBA
MATERIAL INSPECTED THIS VISIT
Item Code Quantity Description Tag No., Batch No.,
Serial No., Cast,
Heat No.
Witnessed Burst Test for Cylinders
1 M 40488
(Batch No. LPG/48 L/3404 - SR.No: — M 40280 to M 40682
Witnessed Burst Test for Cylinders
1 M 40810
(Batch No. LPG/48 L/3405 - SR.No: — M 40683 to M 40884
Witnessed Burst Test for Cylinders
1 M 41091
(Batch No. LPG/48 L/3406 - SR.No: — M 40885 to M 41287
Witnessed Burst Test for Cylinders
-- 1 M 42495
(Batch No. LPG/48 L/3407 - SR.No: — M 41288 to M 41690
Witnessed Burst Test for Cylinders
1 M 42699
(Batch No. LPG/48 L/3410 - SR.No: — M 42497 to M 42999
Witnessed Burst Test for Cylinders
1 M 43211
(Batch No. LPG/48 L/3411 - SR.No: — M 43000 to M 43502
Witnessed Burst Test for Cylinders
1 A 41252
(Batch No. LPG/108 L/471 - SR.No: — A 41074 to A 41325
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
Vendor / Report Hours: 1 Visit Travelling Hours: Distance Travelled:

2.0 PERSONS PRESENT:

LLC
3.0 DOCUMENTATION USED / APPROVAL STATUS:

4.0 INSPECTION CARRIED OUT (reference ITP clause if applicable):

 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

 Witnessed Burst Test for the below mentioned cylinders with Achieved Result :-
Burst Standard
Cylinder
Pressure
Capacity Serial No.
Achieved
(Liter)
(Bar)
48 M 40488 85.62 OS 120:1986
48 M 40810 84.62 OS 120:1986
48 M 41091 84.12 OS 120:1986
48 M 42495 83.62 OS 120:1986
48 M 42699 88.12 GSO ISO 22991:2008
48 M 43211 88.62 GSO ISO 22991:2008
108 A 41252 74.12 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 21/04/2019 20/04/2020 --

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.

9.
- End of Report –

L5-FMT-046 Rev. 03