Part No.

/ Revision Page/Seite
Stamp of Company Inspection Sheet (Artikel-Nr. / Index)
Firmenstempel
Prüfblatt 150502 31 2702 - 1
of
5
von

Anchor block, screwed, short / Ankerblock, geschraubt, kurz

Order No. / Auftrag Nr.: ............................................ Inspected/Supplied Quantity / Prüf-/Liefermenge:
Project / Projekt: ............................................ Visual / Sicht (100%): ....................... Pcs. / Stck.
Order quantity With measurement tool
..................... Pcs. / Stck. Mit Meßwerkzeug (5%): Min ................. Pcs. / Stck.
Bestellmenge:

General Requirements / Allgemeine Anforderungen:

Inspection Certificatel 3.1 Available / Vorhanden
Abnahmeprüfzeugnis 3.1
(acc. / nach DIN EN 10204) Not available / Nicht vorhanden

Corrosion Protection / Korrosionsschutz Available / Vorhanden

acc. to drawing no.: / nach Zeichnung Nr.: 00 00 9539 None / Keiner
Requirement Nom. Min. Max.
(see drawing) Sample / Probe
Value Value Value
Anforderung
(siehe Soll- Min. Max.
Zeichnung) wert Wert Wert 1 2 3 4 5
Ø A 259,00 258,55 259,00
Ø B 247 246,5 247,5
C 198 197 199
D 235 234 236
Ø E 246 245 247
Ø F 262 261 263
Ø G 20,5 20,2 20,5
H Ra 6,3 (Rugotest) Yes No Yes No Yes No Yes No Yes No
32 31,9 32,2
I* 7° 6°50‘ 7°05‘ Yes No Yes No Yes No Yes No Yes No

* to be checked with cone gauge acc. to quality instruction drawing no.

902 003 0036 0 992 003 0002
zu prüfen mit Konus - Prüflehre nach Arbeitsanweisung Zeichnung-Nr.
U ** Yes / No Yes No Yes No Yes No Yes No Yes No
** with template drawing no. / mit Schablone Zeichnung-Nr. 400 31 9571
W Existing / vorhanden Yes No Yes No Yes No Yes No Yes No

X/Y Existing / vorhanden Yes No Yes No Yes No Yes No Yes No

Delivery corresponds to drawing/

Yes No
Lieferung entspricht Zeichnungsvorgaben
....................................................................................
Approval for delivery / Lieferfreigabe: Yes No Yes / Ja No / Nein
Date/Datum; Signature/Unterschrift; Stamp of Company/Firmenstempel

Approval for application / Anwendungsfreigabe:

Yes / Ja Approval under restriction (see Notes) /

No / Nein eingeschränkte Freigabe (siehe Bemerkungen)

Notes / Bemerkungen: ..............................................................................................................................................

...................................................................................................................................................................................
...................................................................................................................................................................................

Copy to / Kopie an: .....................................................

.................................................................................... .................................................................................
Date/Datum; Signature/Unterschrift
 Part No. / Revision Page
Stamp of Company Add. Inspection Sheet
150502 31 2702 - 2 of 5
Anchor block, screwed, short / Ankerblock, geschraubt, kurz
Order No.: ...............................

Project: ...............................

Order quantity: ............................... Pcs

1)
Inspected/Supplied Quantity :

Visual (100%): .............................Pcs.

Min ……………………Pcs.
With measurement tool (5%):
1)
Quantity related to every partial delivery

Inspection Protocol for Corrosion Protection – Electroplated Coating acc. to DIN EN 12329
Measurement device:

Electroplated coating supplier (applicable if provided by others):

2)
Sample/ Average value of measured thickness
Date
Probe [µm]
1
2
3
4
5
2)
The stated average value for the measured thickness is a result of a minimum of 5 single measurements (see page 4)

Inspection Protocol for Corrosion Protection – Thermal Spraying acc. to DIN EN ISO 2063
Measurement device for roughness: Measurement device for thickness:

Thermal spraying supplier (applicable if provided by others):

Cleanliness degree Roughness (acc. to Average value of Minimum

Sample/ EN ISO 8503-1) measured thickness3) 4) Thickness
Date (acc. to
Probe
EN ISO 8503-1) [µm] [µm] [µm]
1 100
2 100
3 100
4 100
5 100
3)
Required average value of measured thickness according to DIN EN ISO 2063 (edition May 2005)
4)
Reference areas and quantity of measurements (see page 4) according to DIN EN ISO 2063 (edition May 2005)
 Part No. / Revision Page
Stamp of Company Add. Inspection Sheet
150502 31 2702 - 3 of 5
Anchor block, screwed, short / Ankerblock, geschraubt, kurz
Order No.: ...............................

Project: ...............................

Order quantity: ............................... Pcs

1)
Inspected/Supplied Quantity :

Visual (100%): .............................Pcs.

Min ……………………Pcs.
With measurement tool (5%):
1)
Quantity related to every partial delivery

Terms of Application of Additional Coating

Factory-made / Coating Factory : On Site
Application Date: Time:

e.g. sweeping of galvanization before coating,

1 Surface Preparation
cleaning
e.g. base surface preparation, intermediate coat,
2 Working Step
top coat
3 Application Procedure e.g. airless, brush
4 Weather Conditions
Measurement Device (Lines 5 -8)
5 Air Temperature [°C]
6 Component Temperature [°C]
7 Dew Point [°C]
8 Relative Humidity [%]
9 Compound Name, Compound-no.
10 Colour
11 Batch-no. acc.to inspection certificate 3.1
12 Remarks Incidents, anomalies
Coating Company Place Date
Signatures
…………………...................... …………………...................... …………………......................

Inspection Protocol for Additional Coating

Measurement device:

Designation of Intermediate coating: Designation of Top coating:

Intermediate Coating Additional Coating

Sample/ Average value of Minimum Average value of Minimum
Date 2) 2)
Probe measured thickness thickness measured thickness thickness
[µm] [µm] [µm] [µm]
1 80 80
2 80 80
3 80 80
4 80 80
5 80 80
2)
The stated average value for the measured thickness is a result of a minimum of 5 single measurements (see page 5)
 Part No. / Revision Page
Stamp of Company Add. Inspection Sheet
150502 31 2702 - 4 of 5
Anchor block, screwed, short / Ankerblock, geschraubt, kurz
Measurement Positions (Electroplated Coating only!)

1, 2
3, 4, 5

Inspection Protocol for Corrosion Protection – Electroplated Coating acc. to DIN EN 12329

Sample/ Position 1 Position 2 Position 3 Position 4 Position 5 Average

Date [µm] [µm] [µm] [µm] [µm] Value1)
Probe
1
2
3
4
5
1)
The average value shall be transferred to page 2

Measurement Positions (Thermal Spraying only!)

1 10mm

10mm

2 One measuring position

consists of 3 single sample
measurings

Inspection Protocol for Corrosion Protection – Thermal Spraying acc. to DIN EN ISO 2063

Position 1 Position 2
Sample/ Average
Date Sample 1 Sample 2 Sample 3 Average Sample 1 Sample 2 Sample 3 Average Value2)
Probe
[µm] [µm] [µm] Value [µm] [µm] [µm] Value
1
2
3
4
5
2)
The average value shall be transferred to page 2
 Part No. / Revision Page
Stamp of Company Add. Inspection Sheet
150502 31 2702 - 5 of 5
Anchor block, screwed, short / Ankerblock, geschraubt, kurz
Measurement Positions

1 10mm

10mm

2 One measuring position

consists of 3 single sample
measurings

Inspection Protocol for Additional Coating

Intermediate Coating
Position 1 Position 2
Sample/ Average
Date Sample 1 Sample 2 Sample 3 Average Sample 1 Sample 2 Sample 3 Average Value1)
Probe
[µm] [µm] [µm] Value [µm] [µm] [µm] Value
1
2
3
4
5

Top Coating
Position 1 Position 2
Sample/ Average
Date Sample 1 Sample 2 Sample 3 Average Sample 1 Sample 2 Sample 3 Average Value1)
Probe
[µm] [µm] [µm] Value [µm] [µm] [µm] Value
1
2
3
4
5
1)
The average value shall be transferred to page 3