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UNITATEA ____________________________________________________________________________ __ ŞANTIER ____________________________________ PUNCT DE LUCRU ____________________________ OBIECTUL_____________________________________________________________________ __________ PROCES-VERBAL PENTRU VERIFlCAREA CALITĂŢII LUCRĂRILOR CE DEVIN ASCUNSE Nr._____ Data_____________ Faza din lucrare supusă verificării: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________ Elementele de identificare (sector, porţiune, ax, cotă, etc.): ___________________________________________________________________________________ ___________________________________________________________________________________ ____________ Verificările s-au făcut pe baza prevederilor proiectului nr. _____________, planşele nr. ________________ sau a dispoziţiei de şantier nr.______________ din data de ________________________ . Concluzii: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

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Page 1: Anexa10 FD .doc

UNITATEA ______________________________________________________________________________

ŞANTIER ____________________________________ PUNCT DE LUCRU ____________________________

OBIECTUL_______________________________________________________________________________

PROCES-VERBAL PENTRU VERIFlCAREA CALITĂŢII

LUCRĂRILOR CE DEVIN ASCUNSENr._____ Data_____________

Faza din lucrare supusă verificării: __________________________________________________________________________________________

__________________________________________________________________________________________

Elementele de identificare (sector, porţiune, ax, cotă, etc.):

__________________________________________________________________________________________

________________________________________________________________________________________

Verificările s-au făcut pe baza prevederilor proiectului nr. _____________, planşele nr. ________________ sau a dispoziţiei de şantier nr.______________ din data de ________________________ .

Concluzii:

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

Numele Prenumele Semnătura

CONSTRUCTOR: _________ ____________ ___________________________ _____________

BENEFICIAR _________ ____________ ___________________________ _____________

PROIECTANT _________ ____________ ___________________________ _____________

GEOLOG _________ ____________ ___________________________ _____________


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