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 : _____________ _____________ _______________