UNITATEA:..................................................................................................................................................................

SANTIER:....................................................................................................................................................................

PUNCT DE LUCRU:....................................................................................................................................................

OBIECTUL: ................................................................................................................................................................

PROCES - VERBAL PENTRU VERIFICAREA CALITATII

LUCRARILOR CE DEVIN ASCUNSE

Nr. _____ Data ____________

Faza din lucrare supusa verificarii:

__________________________________________________________________________________________

Elemente de identificare ( sector, portiune, ax, cota, etc. )

__________________________________________________________________________________________

Verificarile s-au facut pe baza prevederilor proiectului nr. _____________________________________________

Planselor nr. ________________________________________________________________________________

sau a dispozitiilor de santier nr. _________________________________________________________________

Concluzii:__________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

NUMELE PRENUMELE SEMNATURA

CONSTRUCTOR ...................................................................................................................................................

BENEFICIAR ........................................................................................................................................................

PROIECTANT .......................................................................................................................................................

CTCC ....................................................................................................................................................................

RTE ......................................................................................................................................................................

Atestam refacerea ( remedierea ) lucrarilor conform prevederilor proiectului.

Data: ____________________

NUMELE PRENUMELE SEMNATURA

CONSTRUCTOR ...................................................................................................................................................

BENEFICIAR ........................................................................................................................................................

PROIECTANT .......................................................................................................................................................

CTCC ....................................................................................................................................................................

RTE ......................................................................................................................................................................