Anexa 4

SANTIER ___________________________ PUNCT DE LUCRU _______________

OBIECTUL ________________________________________________________________

PROCES VERBAL PENTRU VERIFICAREA CALITATII LUCRARILOR CE DEVIN

ASCUNSE

Nr.___________ Data____________

Faza din lucrare supusa verificarii:

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____________________________________________

Elementele de identificare (sector, portiune, ax, cota etc.):

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Verificarile s-au facut pe baza prevederilor proiectului nr._______ plansele nr._______ sau a
dispozitiei de santier nr.________ din data de _________.

Concluzii:
___________________________________________________________________________
___________________________________________________________________________
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CONSTRUCTOR: BENEFICIAR
/DIRIGINTE
SANTIER:
Numele: ____________ ____________
Prenumele: ____________ ____________
Semnatura: ____________ ____________
Atestam refacerea (remedierea) lucrarilor conform prevederilor proiectului.
CONSTRUCTOR BENEFICIAR
/DIRIGINTE DE
SANTIER
Numele: ____________ ____________
Prenumele: ____________ ____________
Semnatura: ____________ ____________