Document Status Code

Status Code Status Description

F Final Certified: Work May Proceed

Comments as indicated: Revise and Resubmit;
A Work may proceed subject to incorporation of
changes as indicated
Comments as indicated: Revise and
B
Resubmit Work may not proceed
C Review not required: Work may proceed
“Permission to proceed does not constitute acceptance of design
details, calculations, analysis, test methods of materials developed or
selected by the vendor / contractor, and does not relieve the vendor /
contractor from full compliance with contractual obligations.”
Document status code assigned by:
Name:
DARREN STEWARD
05Date:
Oct 2015Signature:
 ITP No. DATE DISCIPLINE:
INSPECTION AND TEST PLAN
MD-512-0G00-CN-CV-
ITP FOR CONCRETE WORKS CIVIL
ITP-KB64-0002_C01
PROJECT TITLE: CONTRACTOR/SUBCONTRACTOR

UMM WU'AL PHOSPHATE PROJECT SEG

INSPECTION RESPONSIBILITY
Verifying ASSIGNMENTS
ITEM PROJECT PHASE & ACCEPTANCE
Quality Related Activity Reference Document & REMARKS
NO. ACTIVITY CODE CRITERIA
Form #
SEG JACOBS Ma'den/ FLOUR

1.0 DOCUMENT REVIEW

MD-101-SMEM-EG-ST-SPC-
1.1 Approved Concrete Design Mix
0004
As per ASTM C1202 QCL-Q-001 RH R R

2.0 MATERIAL RECEIVING

As per ASTM A615/A615

Reinforcinf Bars Receiving MD-101-SMEM-EG-ST-SPC- Grade 60, ASTM
2.1
Inspection 0005 A775/A775M, ASTM
QCL-Q-003 H R/W R
A767

Type I or V Cement
unless otherwise
Ready Mix Concrete receiving MD-101-SMEM-EG-ST-SPC-
2.2
Inspection 0004
specified - ASTM C150, QCL-Q-002 H R R
Aggregates - ASTM C33,
ASTM C586, ASTM C494

3.0 INSTALLATION

MD-101-SMEM-EG-ST-SPC-
3.1 Formworks Inspection
0005

Dimension and Alignment As per Drawing and ACI

Checking 117
QCL-Q-004 H W S

Page 1 of 4
 ITP No. DATE DISCIPLINE:
INSPECTION AND TEST PLAN
MD-512-0G00-CN-CV-
ITP FOR CONCRETE WORKS CIVIL
ITP-KB64-0002_C01
PROJECT TITLE: CONTRACTOR/SUBCONTRACTOR

UMM WU'AL PHOSPHATE PROJECT SEG

INSPECTION RESPONSIBILITY
Verifying ASSIGNMENTS
ITEM PROJECT PHASE & ACCEPTANCE
Quality Related Activity Reference Document & REMARKS
NO. ACTIVITY CODE CRITERIA
Form #
SEG JACOBS Ma'den/ FLOUR

Clear Covering of Rebar As per Drawing QCL-Q-004 H W S

Form surface treatment

checking
Visual QCL-Q-004 H W S

Support and Shoring checking Approved Procedure QCL-Q-004 H W S

Chamfer Checking (If required) As per Drawing QCL-Q-004 H W S

MD-101-SMEM-EG-ST-SPC-
3.2 Installation of Reinforcing Bars and Embedded Items
0005

Reinforcement Cut, Bend, As per Bending Schedule, Method Statement for Bar Bending
Formed Dimensions Checking ACI 117, 315
QCL-Q-005 H W S and Fabrications.

Reinforcement Placement
Checking
As per Drawing QCL-Q-005 H W S

Anchor Bolts As per Drawing QCL-Q-005 H W S

Pipe Sleeves As per Drawing QCL-Q-005 H W S

Insert Plates As per Drawing QCL-Q-005 H W S

Page 2 of 4
 ITP No. DATE DISCIPLINE:
INSPECTION AND TEST PLAN
MD-512-0G00-CN-CV-
ITP FOR CONCRETE WORKS CIVIL
ITP-KB64-0002_C01
PROJECT TITLE: CONTRACTOR/SUBCONTRACTOR

UMM WU'AL PHOSPHATE PROJECT SEG

INSPECTION RESPONSIBILITY
Verifying ASSIGNMENTS
ITEM PROJECT PHASE & ACCEPTANCE
Quality Related Activity Reference Document & REMARKS
NO. ACTIVITY CODE CRITERIA
Form #
SEG JACOBS Ma'den/ FLOUR

MD-101-SMEM-EG-ST-SPC-
3.3 Concrete sampling, Testing and Placement
0005

ACI 301, ACI 304R, ACI

Placing Concrete
304.2R
QCL-Q-006 H W S Attached Pour Log for daily Pouring

Slump Test/Temperature ACI 311.5R QCL-Q-006 H W S

Number Test Cylinder ACI 363R QCL-Q-006 H W S

MD-101-SMEM-EG-ST-SPC-
3.4 Formwork Stripping, Concrete Finishing and Curing
0005

Withness the first 2 formwork

Stripping of Formworks QCL-Q-007 H W S
As per Drawing, ACI 301, stripping activities and once evry 4
ACI 347 occurrences thereafter.

Finishing of Concrete As per Drawing, ACI QCL-Q-007 H W S

302.1R

SEG to witness the first 2 curing

days of structural concrete and
As per ACI 301, ACI 308, once every 3 occurrences
Curing of Concrete
ACI 305R
QCL-Q-007 H S S
thereafter, Jacobs surveilance for
the first 2 curing days of structural
concrete.

Page 3 of 4
 ITP No. DATE DISCIPLINE:
INSPECTION AND TEST PLAN
MD-512-0G00-CN-CV-
ITP FOR CONCRETE WORKS CIVIL
ITP-KB64-0002_C01
PROJECT TITLE: CONTRACTOR/SUBCONTRACTOR

UMM WU'AL PHOSPHATE PROJECT SEG

INSPECTION RESPONSIBILITY
Verifying ASSIGNMENTS
ITEM PROJECT PHASE & ACCEPTANCE
Quality Related Activity Reference Document & REMARKS
NO. ACTIVITY CODE CRITERIA
Form #
SEG JACOBS Ma'den/ FLOUR

MD-101-SMEM-EG-ST- MD-512-0G00-
4.0 INSPECTION RECORD FOR LEAK TEST ACI 350.1-01 CN-CV-CHK- H H S
SPC-0005, Sec. 6.3 KB64-0024_A01

MD-101-SMEM-EG-ST-SPC-
5.0 Final Acceptance
0005
Repaired(If required) QCL-Q-008 H H R Review and Approval of Documents

LEGEND
W Witness Inspection/Test Hold Point for QC Inspection or Test RH Review and Approval of Documents
R Review of Documents

GENERAL NOTES

1 Surveillance: QA/QC organization to monitor work in progress without notice from Construction Organization

2 Witness: QA/QC organization shall be notified of the timing of Inspection or test in advance. However, the inspection or test shall be performed as scheduled if the QA/QC organization representative is not present.

3 Hold: QA/QC organization shall be notified of the timing of inspection or test in advance. Inspection or test shall not be carried out without the QA/QC organization representative in attendance.

Page 4 of 4
 CHECKLIST NUMBER DATE QR NUMBER
INSPECTION CHECKLIST APPROVED

MD-512-0G00-CN-CV-
INSPECTION RECORD FOR LEAK TEST CHK-KB64-0024_A01
REV.: 01 Civil

PROJECT TITLE CONTRACT NO. CONTRACTOR / SUBCONTRACTOR

UMM WU'AL PHOSPHATE PROJECT SEG

LAYOUT DRAWING NUMBER REV. NO.

ITP NUMBER ACTIVITY NUMBER INSPECTION LEVEL

Testing start time Testing finish time WORK PERMIT REQUIRED

Ambient temperature Water temperature

ITEM
ACCEPTANCE CRITERIA REFERENCE PASS FAIL N/A RE-INSP DATE
No.

A Preparation work

Prior to the leakage test, the concrete repair work should be done after curing
ACI 350.1-01
A1 work be finished and it should be approved after inspection by JACOBS. Any
Chapter 2
surface defects are not allowed
The cleaning work should be done inside the pit and the exterior side coating work ACI 350.1-01
A2
is not allowed before the leakage test is finished Chapter 2

Standing water in or outside of the tank that would interfere with the observation of ACI 350.1-01
A3
the exposed concrete surfaces of the tank shall be removed. Chapter 2

ACI 350.1-01
A4 All openings should be sealed if have before leak test.
Chapter 2

ACI 350.1-01
A5 The designed level should be issued by JACOBS and marked before leakage test.
Chapter 2

The potable water supplier should be confirmed and the water test report also be
A6 ACI 350.1-01
applied.
The water shall be kept at the test level of unlined concrete tanks for at least three
ACI 350.1-01
A7 days prior to the actual test.If any flow of water is observed from the pit exterior
2.3
surfaces, including joints or cracks, the defect causing the leakage shall be

B Leak test

ACI 350.1-01
B1 The initial filling should not exceed a rate of 1.2m/h
Chapter 2

Filling water to maintain the water level reaching the design level for 7days and no ACI 350.1-01
B2
damp spots, seepage, and leakage was found Chapter 2

REMARKS:

Contractor / Subcontractor JACOBS

Construction Representative*
Work is Complete and Ready for Inspection:
Name, Initials and
Date:
QC Inspector Jacobs Representative
Work / Rework May QC Record
Name, Initials and Performed Inspection T&I Witnessed Work Verified
Proceed Name, Initials and Date: Reviewed
Date:
QC Supervisor
Quality Record Approved:
Name, Sign and
Date:

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