Date: 14-OCT-2024

Technical/Non Technical/TQ/FCD Submittal

Contract No.: 092-C48 (SP-231000003)
Project Name: T-274 Tapline Road Intersection Project
Transmittal No: TS-5014

Royal Commission for Jubail and Yanbu X Technical Submittal (TS)

Madinat Al-Jubail Al-Sinayah - 31961 Non-Technical Submittal (NTS)
Kingdom of Saudi Arabia Technical Query (TQ)

Field Change Document (FCD)

ATTENTION: MR. ABDIWAHAB I. ABDI
Resident Engineer

SUBJECT: INSPECTION TEST PLAN FOR EXCAVATION AND BACKFILLING

Discipline:
X Civil / Structural Architectural Mechanical Electrical/Instrument/Telecom General

TECHNICAL SUBMITTALS NON-TECHNICAL SUBMITTALS

Material Approval X ITP (Inspection and Test Plan IFC / Final Quantity

Method Statement As Built Drawings CV / Resume

Temporary Work Design Plan Schedule

Shop Drawing Monthly Quality Report

Test Report Organization Chart

Design Calculations

O and M Others: Others:

Please Specify Please Specify

Materials Submittal
Rev
Document No. Discription
No. RC CSI Code:
Manufacture Name Supplier Name
(e.g 16-01)

INSPECTION TEST PLAN FOR

01-5014-00 00 EXCAVATION AND BACKFILLING

Check Note: Please Complete all the above details shall be completed prior to submission to DDC

ARUMUGAM
Project Manager
STAFA A. AL-SHIMI
 INSPECTION AND TEST PLAN (ITP)
Contract:092-C48 (SP231000003) SHINE COMPANY LTD.
T-274 TAPLINE ITP: SCL-PRJ-ITP-CE-001
INTERSECTION EXCAVATION AND BACKFILLING
Rev: 00
PROJECT

UNIT/ AREA / LOCATION DISCIPLINE EQUIPMENT DESCRIPTION / TAG NUMBER

T-274 Tapline Intersection Road CIVIL WORKS Excavator, Dump Truck, Bulldozer, Roller, Loader

Method of Verification Report

Inspection / Test Requirements Reference Document(s) 12
(see Legend below) Inspection
Activity
Activity Description Request Hold
# Test or Inspection Contr.
Stage/Frequency Code, Spec, Etc Acceptance Criteria R/C Others Point Release
Performed QC
Reference #

1. EXCAVATION

Before start of RC Spec. Section Approved RC

1.1 Obtain Permit for Excavation. Document Review RC Permit Procedure R R
excavation works 02315, par. 1.06 (2.) Permit Form
Survey Setting:
• Bench Mark, Survey
Control Points RC Spec. Section IFC Drawings, RC Inspection
Visual Inspection/ Before start of
1.2 • Location & Lay-out Area to 02315 pars. 1.09, 3.01, Spec. Section 02315 I I Report, Survey
Survey Instrument excavation
be excavated. 3.02, IFC Drawings pars. 1.09, 3.01, 3.02 Report
• Locations of Underground
Services by GPR.
IFC drawings, RC Spec.
Section 02315 par. 1.09
Protection or relocation of
A. 1 - 13, Par. 3.03 A.6, Approved Method of Inspection
existing underground utilities Before start of
1.3 Visual Inspection RC Spec. Section Statement, Approved HI HI Report/ Hold
and other structures as excavation
02310 par. 3.01 (7), Shop Drawings Point Release
required
Approve Method of
Statement

IFC drawings, RC IFC drawings, RC

Clearing, Grubbing & Rough Before start of Specs. Section 02315 Spec. Section 02315 Inspection
1.4 Visual Inspection I WI
Grading excavation pars. 1.09, 02310 part part 1.09, 02310 pars. Report
3.01 – 3.03 3.01 – 3.03
Before and /or RC Spec. Section Inspection
Shoring & bracing or sloping
1.5 Visual Inspection during excavation 02315 pars 3.02, 3.03 Safety Requirements, HI HI Report/ Hold
and dewatering as required.
stage (A.6) Point Release
Inspection
Excavation upto final profile IFC drawing, RC Spec. IFC drawing, RC Checklist,
Visual Inspection/ During
1.6 (Elevation & Dimension) for Section 02315 pars. Spec. Section 02315 I/H I/H Inspection
Survey Instrument excavation
conformity to IFC drawing. 3.03, 3.04 pars. 3.03, 3.04 Report/ Hold
Point Release
Page-1
 INSPECTION AND TEST PLAN (ITP)
Contract:092-C48 (SP231000003) SHINE COMPANY LTD.
T-274 TAPLINE ITP: SCL-PRJ-ITP-CE-001
INTERSECTION EXCAVATION AND BACKFILLING
Rev: 00
PROJECT

UNIT/ AREA / LOCATION DISCIPLINE EQUIPMENT DESCRIPTION / TAG NUMBER

T-274 Tapline Intersection Road CIVIL WORKS Excavator, Dump Truck, Bulldozer, Roller, Loader

Method of Verification Report

Inspection / Test Requirements Reference Document(s) 12
(see Legend below) Inspection
Activity
Activity Description Request Hold
# Test or Inspection Contr.
Stage/Frequency Code, Spec, Etc Acceptance Criteria R/C Others Point Release
Performed QC
Reference #

Excavated area free from IFC drawing, RC Spec. IFC drawing, RC Inspection
Excavation reach
1.7 extraneous material and Visual Inspection Section 02315 pars. Spec. Section 02315 HI WI Report/ Hold
the final level
water. 3.03, 3.04 pars. 3.03, 3.04 Point Release

2. Backfilling, Filling & Compaction

RC Spec. Sections RC Spec. Sections Approved

Fill Materials Conforming to 02310 par. 1.07, RC 02310 par. 1.07, RC Material
2.1 Classification Test Random HI HI
RC Specs. Spec Section 02315 Spec Section 02315 Submittal, Hold
pars. 1.07, 2.03 pars. 1.07, 2.03 Release Form
Inspection
Filling, Spreading of fill IFC Drawings, RC Spec. IFC Drawings, RC
Checklist,
2.2 materials in layer and Visual Inspection Every Layer Sections 02310 par. Spec. Sections HI WI
Inspection
compaction (layer/ lifts) 3.05 02310 par. 3.05
Report

IFC Drawings, RC Spec. IFC Drawings, RC Laboratory FDT

Field Density Test for every
2.3 Compaction Test Every Layer Section 2315 par. 3.05, Spec. Section 2315 HT HR T Results/ Hold
layer lifts
Section 02310 par. 3.07 Par. 3.05 Point Release
Survey Report,
Grading to required Cross Visual Inspection/ Completion of Inspection
2.4 IFC Drawings IFC Drawings HI HI
section and elevation Survey Instrument Final Layer Request/ Hold
Point Release
Contractor QC Date & Signature /Stamp No. RC Insp. (Date & Signature.) Others

MOHAMMED ZIYA NEMAN

Legend: I – Inspection: R – Document Review; T – Test; W - Witness Point; H - Hold Point

Page-2
 SHINE COMPANY LTD.
T-274 TAPLINE INTERSECTION PROJECT

FIELD SURVEY FOR EXCAVATION

IR / RECORD No.: Doc No.:

CONTACT NO.: DATE

SURVEY BASIS AREA NO.:

DRAWING No.:

LOCATION DESCRIPTION

COORDINATE
POINTS NO. REMARKS
N E

SURVEY
AND
SETTING
OUT

Excavation Depth m Check the stability of slope Satisfied Unsatisfied

Elevation EL m Excavation Bottom Condition Satisfied Unsatisfied

Calibration Record

Survey Equipment Series No. Manufacturer Calibration Date Expiration Date

SCL QC ENGINEER R C ENGINEER

NAME

SIGNATURE

DATE
 Shine Company Ltd.
T-274 Tapline Intersec�on Road Project

EXCAVTION AND BACKFILLING

RFI NO. DOC NO.

CONTRACT NO DATE:

DISCIPLINE: AREA:

DRAWING NO.
LOCATION
DESCRIPTION:

INSPECTION RESULTS
S.No ACCPTANCE CRITERIA REMARKS
YES NO N/A
Check the Co-ordinates and eleva�on for
1. ☐ ☐ ☐
excava�on is marked as per drawing
2. Check the layout and level for excava�on. ☐ ☐ ☐
Check the sloping/benching/shoring is
3. maintained as per the depth of ☐ ☐ ☐
excava�on
4. Check the slope, width and length ☐ ☐ ☐
Verifica�on of Soil materials as per IFC
5. ☐ ☐ ☐
Drawing and applicable specifica�ons.
Verify the Soil data test performed by
6. third party approved agency for ☐ ☐ ☐
backfilling material.
Verify Soil samples are collected for
7. ☐ ☐ ☐
proctor value and report is available.
Verify Soil samples are collected for
8. ☐ ☐ ☐
proctor value and report is available.
9. ☐ ☐ ☐
REFERENCE
DRAWING:

REFERENCE
SPECIFICATION:

COMMENTS

SHINE COMPANY LTD. R.C. ENGINEER

Name:
Signature:
Date:
 Shine Company Ltd.
T-274 Tapline Intersec�on Road Project

Backfilling and Compac�on (FDT Test)

RFI NO. DOC NO.

CONTRACT NO DATE:

DISCIPLINE: AREA NO:

MATERIAL TYPE: EQUIPMENT:

OPTIMUM PROCTOR
MOIISTURE: DENSITY:
BACKFILL
LAYER THICKNESS:
DEPTH:
DRAWING NO.
LOCATION
DESCRIPTION:

INSPECTION RESULTS
S.No ACCPTANCE CRITERIA REMARKS
YES NO N/A
Verifica�on of Soil materials as per IFC
1. ☐ ☐ ☐
Drawing and applicable specifica�ons.
Verify the Soil data test performed by
2. ☐ ☐ ☐
third party approved agency.
Verify Soil samples are collected for
3. ☐ ☐ ☐
proctor value and report is available.
Verify the test is performed for ever layer
4. ☐ ☐ ☐
of compac�on.
Check the Test equipment calibrated valid
5. ☐ ☐ ☐
to date of tes�ng.
Check the Field moisture content of soil
6. ☐ ☐ ☐
acceptable.
Check the succeeding ac�vi�es over
7. tested soil shall commence within 24 ☐ ☐ ☐
hours.
Check the Field density test report
8. acceptable and proctor density achieved ☐ ☐ ☐
as per specifica�on.
Verify the third-party field test report
9. ☐ ☐ ☐
provided and documented.
REFERENCE
DRAWING:
REFERENCE
SPECIFICATION:
COMMENTS:

SHINE COMPANY LTD. R.C. ENGINEER

Name:
Signature:
Date: