TE_3_Daily_Inspection_Report.doc

Technical Exhibit 3

DAILY CONTRACT INSPECTION REPORT

1. CONTRACT NUMBER 3. ABBREVIATED CONTRACT NAME 4. NAME OF CONTACTOR (COMPANY NAME)

2. SPECIFICATION NUMBER 7. WEATHER AND TEMPERATURE

0800 HRS. 1200 HRS. 1500 HRS.

5. NOTICE TO PROCEED DATE

6. ACTUAL DATE STARTED

8a. CONTRACTOR DESCRIBE WORK BEING PERFORMED ( INCLUDE LOCATION OF WORK)

BACKFLOW PREVENTOR MAINTENANCE:

MONDAY :

TUESDAY:

WEDNESDAY:

THURSDAY:

FRIDAY:

8b. NUMBER OF WORKERS ON JOB 8c. NAME OF CONTRACTOR’S REPRESENTATIVE

9. CONTRACTOR RECORD GOVERNMENT REPRESENTATIVE’S INSTRUCTIONS (IF ANY)

10. CONTRACTOR DESCRIBE DIFFICULTIES ENCOUNTERED ( INCLUDING DELAYS, DESCRIBE WORK NOT PERFORMED IN ACCORDANCE WITH

SPECIFICATIONS, CORRECTIVE ACTIONS, ECT.)

11. INSPECTOR EVALUATE CONTRACTOR’S INPUT TO ITEMS 8,9, AND 10

WAS A SITE INSPECTION PERFORMED OF THE WORK IDENTIFIED IN BLOCK 8? YES NO N/A

( DATE Of INSPECTION)

12. ESTIMATED COMPLETION DATE 13. PERCENT COMPLETE 14. CONTRACTOR’S SIGNATURE AND DATE

15. INSPECTOR’S SIGNATURE AND DATE 16. ENGINEERING REVIEW ( SIGNATURE AND DATE)

17. CONTRACTING ADMINISTRATOR’S SIGNATURE AND DATE 18. REPORT IS FOR DATE(S) 19. REPORT SERIAL NUMBER

HFL FORM 1235 PREVIOUS EDITION OBSOLETE ORIGINAL TO: DIRECTORATE OF CONTRACTING

1 JAN 1995 COPIES TO: CONTRACTING OFFICER’S REP., INSPECTOR, CONTRACTOR