Client: Haifa Industrial Services Co.

LLC Vendor: -----

Project: ----- Sub-Vendor: ----
PO No.: 18000259 Location: Rusayl, Muscat
Client Reference: 18/074/HI/YS Assign No.: ---- Report No: 24
Client Contact: Mr.Ibrahim SO No.: ------ Date of Visit :19.04.2018
Work Order No.: TPL-2018-002 Vendor Ref.: ------ Next Visit Date: TBA
MATERIAL INSPECTED THIS VISIT
Item Quantity Description Tag No., Batch No.,
Code Serial No., Cast,
Heat No.
Witnessed Burst Test for Cylinders
1 L 48277
(Batch No. LPG/48 L/3166 - SR.No: L 48070 — L 48472
Witnessed Burst Test for Cylinders
1 L 48666
(Batch No. LPG/48 L/3167 - SR.No: L 48473 — L 48875
Witnessed Burst Test for Cylinders
1 L 49090
(Batch No. LPG/48 L/3168 - SR.No: L 48876 — L 49278
Witnessed Burst Test for Cylinders
-- 1 L 52225
(Batch No. LPG/48 L/3176 - SR.No: L 52100 — L 52602
Witnessed Burst Test for Cylinders
1 L 52825
(Batch No. LPG/48 L/3177 - SR.No: L 52603 — L 53105
Witnessed Burst Test for Cylinders
1 L 53323
(Batch No. LPG/48 L/3178 - SR.No: L 53106 — L 53608
Witnessed Burst Test for Cylinders
1 L 53838
(Batch No. LPG/48 L/3179 - SR.No: L 53609 — L 54111
RESULTS OF Accepted Not ORDER STATUS: Complete Incomplete
INSPECTION: Compliant
1.0 SUMMARY:
Inspection visit was made at Haifa Industrial Services Co LLC. Workshop ,Rusayl to witness Burst Test as per the
client’s request.

Please refer Page 02 & 03 for more details about inspection.

Balance Full PO
ATTACHMENTS: NCR Punchlist Partial Release
Release Release
RECORD OF HOURS
Vendor / Report Hours: 1 Visit Travelling Hours: Distance Travelled:
Inspecting Engineer: Rahul M Reviewed by: Girish Kumar HM Agreed Expenses: Yes No

Date: 19.04.2018 Date: 19.04.2018 Page 1 of 3

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

2.0 PERSONS PRESENT:

3.0 DOCUMENTATION USED / APPROVAL STATUS:

 OS 120:1986
 GSO ISO 22991

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

 Witnessed Burst Test for the below mentioned cylinders with Achieved Result :-

Burst Standard
Cylinder
Pressure
Capacity Serial No.
Achieved
(Liter)
(Bar)
48 L 48277 87.12 OS : 120
48 L 48666 84.62 OS : 120
48 L 49090 86.12 OS : 120
48 L 52225 84.12 GSO ISO 22991
48 L 52825 86.12 GSO ISO 22991
48 L 53323 85.12 GSO ISO 22991
48 L 53838 87.62 GSO ISO 22991

 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

Calibrated Calibration Expiry Certificate N°
Date
Pressure Gauge CALTROLS 150856383 23/04/2017 22/04/2018 --

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 Current Scheduled Delivery Delivery Point Comments

Date
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

9.0 ATTACHMENTS: PO 18000259

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

- End of Report –

L5-FMT-046 Rev. 03