1 The following items have been checked: Yes No Not Req.

1.1 Location and Orientation Correct

1.1.1 As per Drawing N _______ E _________

1.1.2 Actual N _______ E _________

1.2 Top of Elevation Correct

1.2.1 As per Drawing _______ Actual _______

1.3 Embendent Parts Correct

1.3.1 Top of Shims ___________ Top of Anchor Bolts _____________

1.4 Anchor Bolt Size & Type Correct

Project: Certificate No.:

System: Area:Foundation No.:

Reference Drawings:

Customer Logo RELEASE FOR GROUTING

1.5 Equipments/Column Aligned and Leveled

1.6 Type of Grout ______________ Grout Stage _________________________

Remarks

NAME: NAME: NAME:

DATE:

SIGNATURE:

DATE:

SIGNATURE:

DATE:

SIGNATURE:

CUSTOMERETIMAAD QA&QCPREPARED BY

Date: May 22, 2007Page: 1 of 1

Doc. No. QA&QC/FRM-93Rev.: 00

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