UNITATEA __________________

SANTIERUL__________________
OBIECTUL___________________

PROCES VERBAL PENTRU VERIFICAREA CALITATII

LUCRARILOR CE DEVIN ASCUNSE
Nr. _________ Data __________
Faza din lucrare supusa verificarii :

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 :
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
_______________________________
Nume
Prenume
Semnatura
CONSTRUCTOR: _____________ _____________ _______________
BENEFICIAR :
_____________ _____________ _______________
Atestam refacerea ( remedierea ) lucrarilor , conform prevederilor proiectului .
Data ______________
Nume
Prenume
Semnatura
CONSTRUCTOR: _____________ _____________ _______________
BENEFICIAR :
_____________ _____________ _______________