CONSTRUCTION CHECK SHEET

PIPING

Flange Protocol Summary

P-209A1

Sheet 1 of 1

REV 5

PROJECT DESCRIPTION

Line No.

FLANGE PROTOCOL SUMMARY

S.No Flange No. Report No. Initialed by

Contractor and PDO

Date

REMARKS/OBSERVATIONS:

COMPLETED BY CONTRACTOR APPROVED BY CONTRACTOR ACCEPTED BY PDO

NAME NAME NAME

COMPANY COMPANY REF. IND.

SIGN & DATE SIGN & DATE SIGN & DATE