Customer

Logo

RELEASE FOR GROUTING

Project:

Certificate No.:

Foundation No.:

System:

Area:

Reference Drawings:

The following items have been checked:

1.1

Location and Orientation

Yes

As per Drawing

N _______ E _________

1.1.2

Actual

N _______ E _________

Top of Elevation

1.2.1
1.3

As per Drawing

Not Req.

Correct

1.1.1

1.2

No

Correct
_______ Actual _______

Embendent Parts

Correct

1.3.1 Top of Shims ___________ Top of Anchor Bolts _____________

1.4

Anchor Bolt Size & Type

Correct

1.5

Equipments/Column Aligned and Leveled

1.6

Type of Grout ______________ Grout Stage _________________________

Remarks

PREPARED BY

ETIMAAD QA&QC

CUSTOMER

NAME:

NAME:

NAME:

DATE:

DATE:

DATE:

SIGNATURE:

SIGNATURE:

SIGNATURE:

Date: May 22, 2007

Page: 1 of 1

Doc. No. QA&QC/FRM-93

Rev.: 00
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