UNITATEA ___________________________________________________________________

SANTIER _____________________________________________________________________
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:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

CONSTRUCTOR: BENEFICIAR PROIECTANT:

/DIRIGINTE DESANTIER:
Numele: ____________ ____________ ____________
Prenumele: ____________ ____________ ____________
Semnatura: ____________ ____________ ____________

Atestam refacerea (remedierea) lucrarilor conform prevederilor proiectului.

CONSTRUCTOR: BENEFICIAR PROIECTANT:

/DIRIGINTE DESANTIER:
Numele: ____________ ____________ ____________
Prenumele: ____________ ____________ ____________
Semnatura: ____________ ____________ ____________