Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
监理附表 supervision sheet
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT 单项(单元)工程： Work Item (Unit): 施工质量规则附表目录(一) PR-00-CIJ-QU-0002 Construction Quality Rules Annexed Table Index (I) 项目编号： Project No.: 表号 Table No. -A01a -A01b -A02 -A02a 表格名称 Table Title 备注 Remarks 工程开工报审表 Review Request on Commencement of Work 工 程 复 工 报 审 表 Review Request for Resume of Work 施工组织总设计报审表Review Request on Overall Construction Organization Design 工程技术管理文件报审表Review Request on Engineering Technical Management Document -A03 分包单位资格报审表 Review Request on Qualification of Subcontractors -A03a -A04 -A05 -A06 -A07 -A08 -A09 -A10 -A11 -A12 -B01 -B02 -B03 -B04 -B05 -B06 -B07 -C01 -C02 -C03 ( )资质报审表Review Request on Qualification 质量控制点核报审表 Review Request on Quality Control Point Inspection 工程款支付申请表Application for Project Payment 监理工程师通知回复单 Supervision Engineer Notice Response 工程临时延期申请表Application for Temporarily Postponement of Project 费用索赔申请表Application For Claim on Cost Request 材料/构配件/设备报审表 Material/Component/Equipment Review 工程交工报验单Construction Takeover Inspection Request 质量控制点检验通知 Quality Control Point Inspection Notice 主 要 施 工 设 备 进 场 报 审 表 监理工程师通知单 Supervision Engineer Notice 工程暂停令 Work Suspension Order 工程款支付证书Project Payment Certificate 工程临时延期审批表Approval for Postponement of Project Temporarily 工程最终延期审批表Approval for Final Postponement of Project 费用索赔审批表Approval For Claim on Cost 会 议 纪 要（一）Minutes of Meeting (I) 监理工作联系单 Supervision Correspondence 工程变更单Variation Order 工程承包单位及承包内容 Construction Contractor Info. And Scope of Contract
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—01a
单项(单元)工程： Work Item (Unit) 项目编号： 单位工程开工报审表 Project No.: Review Request on Commencement of Work Unit 编号：No. 致（监理单位）To(Supervision Company)：
我方承担的 工程，已完成了开工前的各项准备工作，计划于 年 月 日开工，请审批。 We contracted work of and completed items of preparation work prior to commencement. We planned to commence the work at (Day) (Month) (Year), please review and approve. 附：Attachment: 1. 2. □图纸会审、设计交底 Design countercheck and clarification records □施工组织设计（方案）审批文件（含主要管理人员及特殊工种资格证明）Construction management design (proposal) review and approval document (including main management personnel and special trade qualification certificate) 3. □施工机具与检测试验设备检查 Construction machinery and inspection & testing equipment inspected. 4. 5. 6. 7. 8. □工序质量控制点报审 Work procedure quality control point review request. □施工测量放线 Construction surveying and setting out work completed □主要人员、材料、设备进场 Major personnel, material and equipment mobilized □施工现场道路、水、电、通讯等已达到开工条件 Access road, water, power and communications etc for construction are ready on site for commencing the work. □ 承包单位（盖章）： 项目经理（签字）： 日期： Construction Contractor(Chop) Project manager (Signature) Date 审查意见Review remarks： 专业监理工程师（签字）： 日期： Discipline supervision engineer (Signature) Date 审批结论Review conclusion： 同意 Approve 不同意 Not approve 项目监理机构（章）： 总监理工程师（签字）： 日期： Supervision Com. (Chop Chief supervision engineer (Signature Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the contractor in three copies, once it being reviewed and approved by the supervision company, each of the Owner, Supervision Company and Contractor shall hold one copy.
□□
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—01b 单项(单元)工程： Work Item (Unit): 工 程 复 工 报 审 表 Review Request for Resume of Work 项目编号： Project No.: 编号： No. 致（监理单位）To (Supervision Company： 我方承担的 工程，由总监理工程师签发的第 号工程暂停令指出的原因已清除，经检查已具备了复工条件，请予以审核并批准复工。 The reason resulting in Work Suspension Order No. issued by the chief supervision engineer for the work contracted by us has been eliminated, it’s proven that the conditions for resumption of work has been made ready. Please review and approve. 附：具备复工条件的详细说明Attachment: Detail statement of reasons for resuming the work。 . 承包单位（盖章）： 项目经理（签字）： 日期： Contractor (Chop ) Project manager (Signature) Date 审批意见Review/approval remarks： 审批结论：Review/approval conclusion □具备复工条件，同意复工。 Conditions for resuming work are ready and agree to resume work. □不具备复工条件，暂不同意复工。Conditions for resuming work are not ready and not agree to resume work now. 项目监理机构（章）： 总监理工程师（签字）： 日期： Project supervision company (Chop) Chief supervision engineer (Signature) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This
table shall be filled up and submitted by the contractor in three copies, once it being reviewed by the supervision company, each of the Owner’s Representative, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—02
施工组织设计/施工方案 报审表 项目编号：LDA03/7S04/812041 单项(单元)工程：公用工程 Work Item (Unit):UTILITY Review Request on Overall Construction Project No.: Organization Design/ Construction Project 编号:No. 致(监理单位) To (Supervision Company)： 洛阳石化工程建设监理公司
我方已根据施工合同的有关规定完成了 丽东芳烃项目 UT区FLARE区安装工程吊装作业安全技术方案 的编制，并经我单位上级技术负责人审查批准，请予以审查。 We’ve completed overall construction organization design/ Construction Project for works of as per related requirements as specified in the Construction Contract, which has been reviewed and approved by competent technical leader in our company, we hereby submit it for your review. 附Attachment： UT区FLARE区安装工程吊装作业安全技术方案 承包单位(章)： 湖南大和设备安装有限公司 项目经理（签字）： 日期：
Contractor(Chop) Project manager(Signature): Date: 总监理工程师审查意见：Review remarks of Chief Supervision Engineer: 审查结论Review conclusion： □同意Approve □修改后再报To be resubmitted after revision □重新编制To be compiled again 项目监理机构（章）： 总监理工程师（签字）： 日期： Project supervision company(Chop): Chief supervision engineer (Signature): Date: 业主项目经理审批意见Review remarks of the Owner’s project manager： 审查结论Review conclusion： □同意Approve □修改后再报To be resubmitted after revision □重新编制To be compiled again 业主管理机构（章）： 项目经理（代表）： 日期： Owner’s management level (chop): Project manager (Representative): Date: 注：施工组织总设计/方案审批意见中，特指的重大施工方案须经业主审批。 Note: Major construction method especially specified in review and approval remarks on overall construction organization design / Construction Projectshall be also reviewed and approved by the Owner. 本表由承包单位填报，一式三份，经监理单位审查，业主代表批准后，业主单位、监理单位、承包单位各存一份。 This table shall be filled up and submitted by the contractor in three copies, once it being reviewed by the supervision company and approved by the Owner’s representative, each of the Owner’s Representative, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—02a 单项(单元)工程：公用工程 Work Item (Unit): Utility 工程技术管理文件报审表 Review Request on Engineering Technical Management Document 项目编号：LDA03/7S04/812041 Project No.: 编号：No. 致（监理单位）To (Supervision Company)：洛阳石化工程建设监理公司 现报上关于 丽东芳烃项目UT区、FLARE区安装工程施工组织设计 工程技术管理文件，请予以审定。 The technical management document of works of is hereby submitted for review and approval. 序号 No. 类别 Category 编制人 Prepared by: 册数 Volume(s): 页数 Page(s) 1 2 3 4 单位工程施工组织设计 Construction Organization Design of Single Unit of Work 施工方案Construction Method 编制单位（章）： 技术负责人（签字）： 申报人（签字）： Prepared by(chop): Technical leader (Signature): Submitted by (Signature): 承包单位意见Contractor’s remark： □有 Yes /□无 No 附页 Annexed pages 承包单位（章）： 技术负责人(签字) ： 日期： Contractor (chop) : Technical leader (Signature): Date: 监理机构审核意见Review and approval remarks of the Supervision Company： 审定结论Review conclusion： □同意Approve □修改后再报To be resubmitted after revision □重新编制To be compiled again 专业监理工程师（签字）： 日期： Discipline supervision engineer (Signature): Date: 项目监理机构（章）： 总监理工程师（签字）： 日期：
Project Supervision Com.(Chop): Chief supervision engineer (Signature): Date: 业主项目经理审批意见Review remarks of the Owner’s project manager： 业主管理机构（章）： 项目经理（代表）： 日期： Owner’s management level (chop): Project manager (Representative): Date: 本表由承包单位填报，一式三份，经监理单位审查，业主代表批准后，业主单位、监理单位、承包单位各存一份。 This table shall be filled up and submitted by the contractor in three copies, once it being reviewed by the supervision company and approved by the Owner’s representative, each of the Owner’s Representative, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—03 单项(单元)工程： Work Item (Unit): 项目编号： 分包单位资格报审表 Review Request on Qualification Project No.: 编号：No. of Subcontractors 致（监理单位）To (Supervision Company)： 经考察，我方认为拟选择的 （分包单位）具有承担下列工程的施工资质和施工能力，可以保证本工程项目按合同的规定进行施工。分包后，我方仍然承担总承包单位的全部责任。请予以审查和批准。 After investigation, we believe the selected Subcontractor, has construction qualification and construction capability required for following work and can ensure to complete construction of the project as per contract requirements. Upon subcontracting the work, we will still bear all responsibility as a General Contractor. Please review and approve. 附件Attachment：1、分包单位资质材料Qualification information of the Subcontractor； 2、分包单位业绩材料Achievement information of the Subcontractor。 分包工程名称（部位） Subcontracted work description (Location) 工程数量 Work amount 拟分包工程合同额 Proposed subcontract value 分包工程占全部工程 Subcontracted amount /Total work amount 合 计(Total) 承包单位（章）： 项目经理（签字）： 日期： Contractor (Chop): Project manager (Signature): Date: 专业监理工程师审查意见Review remarks of discipline supervision engineer： 专业监理工程师（签字）： 日期： Discipline supervision engineer (signature): Date: 总监理工程师审核意见Review remarks of the chief supervision engineer： 项目监理机构（章）： 总监理工程师（签字）： 日期： Project Supervision Company (chop) Chief supervision engineer (Signature) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the contractor in three copies, once it being reviewed by the supervision company, each of the Owner’s Representative, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—03a 单项(单元)工程：公用工程 Work Item (Unit)；Utility 项目编号：7S04 ( 湖南大和公司 )资质报审表 Review Request on Qualification Project No. 编号: No. 致（监理单位）To (Supervision Company)：洛阳石化工程建设监理公司 事由Subject:： 现将我公司资质证书等资料报予贵公司，请审核。 内容Content:： 1、 资质证书一份。 2、 营业执照一份。 3、 企业法人营业执照一份。 4、 组织机构代码证一份。 5、 压力管道安装许可证资料一份。 提出单位（章）：湖南大和设备安装有限公司 代表人（签字）： 日期： Issued by(Chop) Representative(Signature) Date 专业监理工程师审查意见Review remarks of discipline supervision engineer： 专业监理工程师（签字）： 日期： Discipline supervision engineer (signature): Date: 总监理工程师审核意见Review remarks of the chief supervision engineer： 项目监理机构（章）： 总监理工程师（签字）： 日期： Project Supervision Company (chop) Chief supervision engineer (Signature) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the contractor in three copies, once it being reviewed by the supervision company, each of the Owner’s Representative, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—04 单项(单元)工程： 公用工程 Work Item (Unit) UTILITY （检验批）分项工程质量报验申请表 (Inspection Batch) Work Item Quality Inspection Application 项目编号：LDA03/7S04/812041 Project No.: 编号： No. 致（监理单位）To (Supervision Company)： 洛阳石化工程建设监理公司 我方已完成了 公用工程消防水管道安装 （检验批）分项工程，经我方检验符合设计、规范要求，请予以验收。 We’ve completed single item of work (inspection batch) of , which has been inspected by us and proven to be in accordance with design and code requirements, please inspect and accept it. 附Attachment： 名称Description 页数Page 编号No. 1、□ 设备、材料、构配件质量证明文件 页 Page Equipment, Material and Components Quality Certificate Document 2、□ 隐蔽工程检查记录表Concealed Work Inspection Record 页 Page 3、□ 予检工程检查记录表Pre-inspected Work Inspection Record 页 Page 4、□ 施工记录Construction Record 页 Page 5、□ 施工试验记录 Construction Test Record, 页 Page 6、□ 工序质量控制点查验认可文件 页 Page Work Procedure Quality Control Point Inspection and Approval Document 7、□ 分项工程质量检验评定记录 页 Page Individual Item of Work Quality Inspection and Evaluation Record 专业质量工程师(检查员）（签字）： 日期 Discipline Quality Engineer (Inspector) (Signature Date 承包单位（章）： 湖南大和设备安装公司(DC) 技术负责人（签字）： 日期： Construction Contractor (Chop) Technical leader (Signature) Date 审查意见： Review Remarks: 审查结论Review conclusion： □合格Qualified □不合格Unqualified 项目监理机构（章）： 专业监理工程师（签字） 日期 Supervision Com. (Chop) Discipline supervision engineer (signature) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。 This table shall be filled up and submitted by the contractor in three copies, once it being reviewed and approved by the supervision company, the Owner, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT A—05 单项(单元)工程： Work Item (Unit): 工程款支付申请表 Application for Project Payment 项目编号：Project No.: 编号：No.: 致To： （监理单位Supervision Company） 我方已完成了 工作，按施工合同的规定，建设单位应在
年 月 日前支付该项工程款共（大写） （小写） 现报上 工程款申请表请予以审查并开具工程款支付证书。 We’ve finished work of . According to the rules of the Construction Contract, owner should pay this project payment total (amount in words) (amount in ordinary figures) before . Now we submit application for project payment. Please check up and write out project payment certificate. 附件Attchment ： 1. 工程量清单;Quantity Bill 2. 计算方法. count method 承包单位（章）： 项目经理（签字）： 日期： Contractor(Seal) Project Manager (Sign) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the construction contractor in three copies. Once it being reviewed and approved by the supervision company, each of the Owner, supervision company and construction contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—06
单项(单元)工程： Work Item (Unit): 项目编号： Project No.: 监理工程师通知回复单 Supervision Engineer Notice Response 编号： No.: 致（监理单位）To (Supervision Company)： 我方接到编号为 的监理工程师通知后，已按要求完成了 工作，现报上，请予复查。 Upon receiving notice No. which is issued by the supervision engineer, we’ve completed work of as required. We, hereby, submit it for your inspection. 详细内容：Detail content: 承包单位（章）： 项目经理（签字）： 日期： Construction Contractor (Chop) Project Manager (Signature) Date: 复查意见Inspection remarks： 项目监理机构（章） 总/专业监理工程师（签字）： 日期： Project supervision company (Chop) Chief/discipline supervision engineer (Signature) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This
table shall be filled up and submitted by the contractor in three copies, once it being reviewed by the supervision company, each of the Owner’s Representative, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT A—07 单项(单元)工程： Work Item (Unit): 工程临时延期申请表 Application for Temporarily Postponement of Project 项目编号：Project No.: 编号：No.: 致To ： （监理单位Supervision Company） 根据施工合同条款 条的规定，由于 原因，我方申请工程延期，请予以批准。 According to the rules of item of construction contract, our side apply project to be postponed, because of 。Please grant our application. 附件Attchment ： 1.工程延期的依据及工期计算 Basis of project to be postponed and count to the time limit for a project 合同完工日期 contract complete time ： 申请延长完工日期Apply complete time to be extend ： 2.证明材料 certificate material 承包单位（章）： 项目经理（签字）： 日期： Ccontractor (Seal) Project Manager (Sign) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the construction contractor in three copies. Once it being reviewed and approved by the supervision company, each of the Owner, supervision company and construction contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT A—08 单项(单元)工程： Work Item (Unit): 费用索赔申请表 Application For Claim on Cost 项目编号：Project No.: 编号：No.: 致To ： （监理单位Supervision Company） 根据施工合同条款 条的规定，由于 的原因，我方要求索赔金额（大写） ，请予批准。 According to the rules of item of construction contract, our side demand compensation of money (amount in words) , because of . Please grant our application. 索赔的详细理由及经过: detailed claim reason and condition 索赔金额的计算： claim money count 附：证明材料 attch: certificate material 承包单位（章）： 项目经理（签字）： 日期： Contractor(Seal) Project Manager (Sign) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the construction contractor in three copies. Once it being reviewed and approved by the supervision company, each of the Owner, supervision company and construction contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—09 单项(单元)工程： Work Item (Unit): 项目编号：Project No. 材料/构配件/设备报审表 Material/Component/Equipment 编号：No. Review Request 致（监理单位）To (Supervision Company)： 现报上 工程进场材料/构配件/设备检验记录，该批物资经我方检验符合设计、规范及合同要求，请予以批准使用。 The record of material, component and equipment inspection for mobilization of work of is submitted as below. This batch of material has been inspected by us and proven to meet requirements of design, specification and contract, please approve application of these materials in this project. 序号 No. 物资名称 Material description 主要规格 Main spec. 单位 Unit 数量 Quantity 选择审报表编号 Review Request Table No. 使用部位 Application location 附：Attachment 1、□出厂合格证Ex-works certificate of compliance 页Page 编号No 2、□厂家质量检验报告Quality inspection report of the vendor 页Page 编号No. 3、□厂家质量保证书Quality guarantee of the vendor 页Page 编号No. 4、□监检、监造文件 Document of manufacturing supervision by residing in factory 页Page 编号No. 5、□商检证 Commodity inspection certificate 页 Page 编号No. 6、□进场检查记录Mobilization inspection record 页Page 编号No. 7、□进场复试报告Mobilization retest report 页 Page 编号No. 8、□备案情况 Put on record 页 Page 编号No. 承包单位（章）： 技术负责人（签字）： 日期： Construction contractor (Chop) Technical leader (Signature) Date: 审查意见Review remarks： □同意使用 Approve to be applied □补报资料Supplementary information to be submitted □重新检验Inspection to be redone □退场demobilization 项目监理机构（章）： 总/专业监理工程师（签字）： 日期： Project supervision company (Chop) Chief/Discipline supervision engineer (Signature) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the construction contractor in three copies. Once it being reviewed and approved by the supervision company, each of the Owner, supervision company and construction contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—10 单项(单元)工程： Work Item (Unit): 工 程 交 工 报 验 单 Construction Takeover Inspection Request 项目编号： Project No.: 编号： No.: 致（监理单位）To (Supervision Company)： 我方已按合同要求完成了 工程，经自检合格， 请予以检查和验收。 We’ve completed work of as per contract requirement, which has been proven to be acceptable upon self-inspection, please inspect and accept it. 附：交工申请、工程实物量清单、交工技术文件。 Attachment: Takeover application, Bills of Quantities, Takeover Technical Deliverables. 承包单位（章）： 项目经理（签字）： 日期 Construction Contractor (Chop) Project Manager (Signature) Date: 审查意见Review remarks: 经初步验收，该工程Upon initial inspection, this work is 1、□符合 □不符合我国现行法律、法规要求；In/not in conformance with current law and rule requirements of the nation. 2、□符合 □不符合我国现行工程建设标准；In/not in conformance with current construction standards of the nation. 3、□符合 □不符合设计文件要求；In/not in conformance with requirements of the design document. 4、□符合 □不符合施工合同要求。In/not in conformance with requirements of construction contract. 综上所述，该工程予验收结论Above all, through inspection, this project shall be concluded as： □合格Qualified □不合格Unqualified； 可否组织正式交工验收Is it proper to organize final takeover inspection and acceptance： □可Yes □否No。 项目监理机构（章） 总监理工程师（签字）： 日期 Supervision Company(chop) Chief supervision engineer (signature) Date 本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。This table shall be filled up and submitted by the contractor in three copies, once it being reviewed and approved by the supervision company, each of the Owner, Supervision Company and Contractor shall hold one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—11 单项(单元)工程：公用工程 Work Item (Unit): UTILITY 工序质量控制点检验通知 Work Procedure Quality Control Point Inspection Notice 项目编号：Project No.: LDA03/7S04/812041 编号：No.:8107 致（监理单位）To (Supervision Company)： 洛阳石化工程建设监理公司 按照施工质量控制程序的规定，我方已完成以下工序质量控制点的施工，并经自检合格，特报请核查确认。（请通知业主专业工程师参加A级质量控制点核查） As per regulations of construction quality control procedure, we’ve completed construction of following work procedure quality control points, which have been proven to be acceptable after self-inspection. Please be noted to inspect and approve. (Please inform discipline engineer of the Owner to attend inspection of Class A quality control points) 附Attachment：自检资料Self-inspection information。 单 位 工 程 Work unit： 质量控制点名称/（级别）Description/Class of quality control point 青岛丽东芳烃UTU消防管道安装工程 管道试压、A级 131-FW-干线 试验压力、保压时间、过程检查、管道复位、填写记录 GB50235-97 年 月 日 具 体 部 位Specific location 检 验 内 容 Content of inspection 检验标准（依据）Inspection standard (Basis) 要求到场检验时间 Required arrive time for attending inspection 承包单位（章）： 湖南大和设备安装公司(DC) (签字）： 日期： Construction contractor(Chop) Technical leader (Signature) Date 专业监理工程师签收Singed for confirmation by the discipline supervision engineer： 定于 年 月 日按要求到现场检验。It’s confirmed to arrive on site on Day Month Year as required for attending inspection. 监理机构（章）： 专业监理工程师（签字）： 日期： Supervision Company (Chop) Discipline supervision engineer (Signature) Date 本表由承包单位填报，一式3~4份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。 其中A级质量控制点应提供业主一份。This table shall be filled up and submitted by the contractor in three to four
copies, once it being reviewed and approved by the supervision company, each of the Owner, Supervision Company and Contractor shall hold one copy. Among which, one copy of document regarding to Class A quality control point shall be submitted to the Owner.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT A—11 单项(单元)工程：公用工程 Work Item (Unit): UTILITY 工序质量控制点检验通知 Work Procedure Quality Control Point Inspection Notice 项目编号：Project No.: LDA03/7S04/812041 编号：No.:8107 致（监理单位）To (Supervision Company)： 洛阳石化工程建设监理公司 按照施工质量控制程序的规定，我方已完成以下工序质量控制点的施工，并经自检合格，特报请核查确认。（请通知业主专业工程师参加A级质量控制点核查） As per regulations of construction quality control procedure, we’ve completed construction of following work procedure quality control points, which have been proven to be acceptable after self-inspection. Please be noted to inspect and approve. (Please inform discipline engineer of the Owner to attend inspection of Class A quality control points) 附Attachment：自检资料Self-inspection information。 单 位 工 程 Work unit： 质量控制点名称/（级别）Description/Class of quality control point 青岛丽东芳烃UTU消防管道安装工程 管道试压、A级 131-FW-干线 试验压力、保压时间、过程检查、管道复位、填写记录 GB50235-97 年 月 日 具 体 部 位Specific location 检 验 内 容 Content of inspection 检验标准（依据）Inspection standard (Basis) 要求到场检验时间 Required arrive time for attending inspection 承包单位（章）： 湖南大和设备安装公司(DC) (签字）： 日期： Construction contractor(Chop) Technical leader (Signature) Date 专业监理工程师签收Singed for confirmation by the discipline supervision engineer： 定于 年 月 日按要求到现场检验。It’s confirmed to arrive on site on Day Month Year as required for attending inspection. 监理机构（章）： 专业监理工程师（签字）： 日期： Supervision Company (Chop) Discipline supervision engineer (Signature) Date 本表由承包单位填报，一式3~4份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。 其中A级质量控制点应提供业主一份。This table shall be filled up and submitted by the contractor in three to four
copies, once it being reviewed and approved by the supervision company, each of the Owner, Supervision Company and Contractor shall hold one copy. Among which, one copy of document regarding to Class A quality control point shall be submitted to the Owner.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT A—12 单项(单元)工程： Work Item (Unit): 主 要 施 工 设 备 进 场 报 审 表 Main construction equipment enter the field Review Request 合同编号 项目编号：Project No.: 编号：No.: 工程名称 致（监理单位）To (Supervision Company)： 我单位承担的 工程的下列主要施工用设备、机具及检测设备、工具已按合同规定进场，请查验，准予使用。 Main construction equipment, machine, inspect equipment and tool that should be use by contractor already arrive, please inspect and approve. 1. 主要施工设备、机具Main equipment, machine 序号 序号 设备名称equipment name 设备名称 equipment name 规格型号数量制造厂spec type number Manufactory 规格型号 spec type 数量number 制造厂Manufactory 技术性能Technique function 进场日期拟用日期拟用何处date enter plan to where use date 校核日期 period of check 有效期period of validity 2. 主要检测设备、工具inspect equipment and tool 附：详细清单 页。 Add: list 施工项目经理部（章）： Project manager's department(chop) 项目经理： 日期： Project manager: date: 监理单位审核意见：remark: 同意上述设备、机具进场。 下列设备、机具能力或数量不能满足施工需要，请尽快按施工进度要求 配足后进场： 序号 设备名称 进场技术性能 应配技术性能 进场数量 应配数量 项目监理机构（章）： Supervision(chop): 总监理工程师： 日期： 监理工程师/监理员： 日期： Chief supervisor: date supervisor: date
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT B—01
单项(单元)工程： Work Item (Unit) 项目编号：Project No. 编号：No. 监理工程师通知单 Supervision Engineer Notice 致To: 事由Subject: 内容Content： 项目监理机构（章）： 总/专业监理工程师（签字） 日期： Supervision Company (Chop) Chief/Discipline Project Supervision engineer(Signature) Date 注：重要监理通知应由总监理工程师签署，监理单位、业主及有关单位各存一份。Note: Important notice from
the supervision company shall be signed by the chief supervision engineer. Supervision company, Owner and related company shall each keep one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT B—02
单项(单元)工程 Work Item (Unit) 项目编号： Project No.: 编号：No 工 程 暂 停 令 Work Suspension Order 致To： （承包单位）(Construction contractor) 由于 的原因，现通知你必须于 年 月 日 时起，对本工程的 部位（工序）实施暂停施工，并按下述要求做好各项工作： Due to the reason of , we hereby inform you to suspend work at location (of work procedure) of since Hour Day Month Year and implement items of work as per following requirements. 项目监理机构（章） 总监理工程师（签字）： 日期：
Project supervision company (Chop) Chief supervision engineer (Signature) Date 注：本表由监理单位签发，签发前应征得业主项目经理同意；业主、监理单位、承包单位各存一份。
Note: This table shall be issued by the supervision company who must obtain consent of the Owner’s project manager prior to issuance. Each of the Owner, supervision company and construction contractor shall keep one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT B—03
单项(单元)工程 Work Item (Unit) 项目编号：Project No. 编号：No. 工程款支付证书 Project Payment Certificate 致to： 根据施工合同的规定，经审核施工单位的付款申请和报表，并扣除有关款项，同意本期支付共（大写） （小写） 请按合同规定及时付款。 After check up the application for payment and report form, deducting related a sum of money, we agree to pay this period, total (amount in words) (amount in ordinary figures) according to the rules of the Construction Contract. Please pay on time according to the rules of Contract. 其中thereinto： 1. 承包单位申报款为： contractor declared payment 2. 本期应扣款为： payment to be deducted this period 3. 应付款为： payment that should be paid 附件Attchment： 1. 承包单位的工程付款申请表及附件 Application for Project Payment and Attchment 2. 项目监理机构审查记录 Project Supervision Com. Examination note 项目监理机构（章）： 总监理工程师（签字）： 日期：
Project Supervision Com.(Seal): Chief Supervision Engineer (Sign): Date: 注：本表由监理单位签发，签发前应征得业主项目经理同意；业主、监理单位、承包单位各存一份。
Note: This table shall be issued by the supervision company who must obtain consent of the Owner’s project manager prior to issuance. Each of the Owner, supervision company and construction contractor shall keep one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT B—04
单项(单元)工程 Work Item (Unit) 工程临时延期审批表 Approval for Postponement of Project Temporarily 项目编号：Project No. 编号：No. 致to： 根据施工合同条款 条的规定，我方对你方提出的 工程延期申请（第 号）要求延长工期 日历天的要求，经过审核评估： According to the rules of item of construction contract, our side check up and evaluate on Application(No. ) for postponement of project temporarily to demand extending time limit for a project day by your side submited. 暂时同意工期延长 日历天。使竣工日期（包括已指令延长的工期）从原来的 年
月 日 延迟到 年 月 日 。请你方执行。 Agreed with temporarily time limit for a project to be extend day. Complete date (include the time limit that had been dictated extending ) will delay from to . Please execute this instruction. 不同意延长工期，请按约定竣工日期组织施工。 Disagreed with time limit for a project to be extend. Please execute construction according to appointed Complete Date. 说明: explanation 项目监理机构（章）： 总监理工程师（签字）： 日期：
Project Supervision Com.(Seal): Chief Supervision Engineer (Sign): Date:
注：本表由监理单位签发，签发前应征得业主项目经理同意；业主、监理单位、承包单位各存一份。
Note: This table shall be issued by the supervision company who must obtain consent of the Owner’s project manager prior to issuance. Each of the Owner, supervision company and construction contractor shall keep one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT B—05
单项(单元)工程 Work Item (Unit) 项目编号：Project No. 工程最终延期审批表 Approval for Final Postponement of 编号：No. Project 致to： 根据施工合同条款 条的规定，我方对你方提出的 工程延期申请（第 号）要求延长工期 日历天的要求，经过审核评估： According to the rules of item of construction contract, our side check up and evaluate on Application(No. ) for postponement of project temporarily to demand extending time limit for a project day by your side submited. 最终同意工期延长 日历天。使竣工日期（包括已指令延长的工期）从原来的 年
月 日 延迟到 年 月 日 。请你方执行。 Agreed with finally time limit for a project to be extend day. Complete date (include the time limit that had been dictated extending ) will delay from to . Please execute this instruction. 不同意延长工期，请按约定竣工日期组织施工。 Disagreed with time limit for a project to be extend. Please execute construction according to appointed Complete Date. 说明: explanation 项目监理机构（章）： 总监理工程师（签字）： 日期：
Project Supervision Com.(Seal): Chief Supervision Engineer (Sign): Date:
注：本表由监理单位签发，签发前应征得业主项目经理同意；业主、监理单位、承包单位各存一份。
Note: This table shall be issued by the supervision company who must obtain consent of the Owner’s project manager prior to issuance. Each of the Owner, supervision company and construction contractor shall keep one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATICS COMPLEX PROJECT B—06 单项(单元)工程： Work Item (Unit): 费用索赔审批表 Approval For Claim on Cost 项目编号：Project No.: 编号：No.: 致To： （承包单位Construction contractor） 根据施工合同条款 条的规定，你方提出的 费用索赔申请（第 号）索赔（大写） 经我方审核评估： According to the rules of item of construction contract, our side check up and evaluate on Application(No. ) For Claim on Cost claiming (amount in words) by your side submitted. 不同意此项索赔。 Disagreed with this claim. 同意此项索赔，金额为（大写） Agreed with this claim. The money (amount in words) 同意/不同意索赔的理由： reason that we agree with / disagree with claim 索赔金额的计算： about claim maney count 承包单位（章）： 项目经理（签字）： 日期： Contractor(Seal) Project Manager (Sign) Date 注：本表由监理单位签发，签发前应征得业主项目经理同意；业主、监理单位、承包单位各存一份。
Note: This table shall be issued by the supervision company who must obtain consent of the Owner’s project manager prior to issuance. Each of the Owner, supervision company and construction contractor shall keep one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目工程
LIDONG AROMATIC COMPLEX PROJECT B—07
单项(单元)工程 Work Item (Unit) 项目编号 会 议 纪 要（一） Minutes of Meeting (I) Project No.: 编号: 第 1 页 共 页 No.: Page 1 of 会议主题：Subject of meeting 时 间Time： 地 点Address： 主持人Sponsor： 记录人Recorder： 出 席 人Attendee 讨论事项和有关决定 Issues discussed and decisions made: 纪要发送单位（或个人）及份数 Following copies of MOM were distributed to parties (or persons) listed as below: 整理 校核 Collated by: Checked by: 签发 Issued by: 注：各有关单位各存一份；涉及设计变更（或偏差）内容，尚须由有关单位和人员出具书面的设计变更（或指示）文件。Note: All related parties shall keep one copy. Related parties and persons shall issue design
change (or instruction) document in written form for any content involving design changes (or discrepancies) in the MOM.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目工程
LIDONG AROMATIC COMPLEX PROJECT B—07
单项(单元)工程 Work Item (Unit) 项目编号： 会 议 纪 要（二） Minutes of Meeting (2) Project No.: 编号: 第 页 共 页 No.: Page of
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT C -- 01
单项(单元)工程： Work Item (Unit) 项目编号： 监 理 工 作 联 系 单 Supervision Correspondence Project No. 编号: No. 致To： （单位）(Company)： 事由Subject:： 内容Content:： 提出单位（章）： 代表人（签字）： 日期： Issued by(Chop) Representative(Signature) Date 注：相关单位各存一份。Note: Parties involved shall each keep one copy.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT C – 02
单项(单元)工程： Work Item (Unit) 项目编号： 工 程 变 更 单 Variation Order Project No. 编号: No. 致To： （监理单位）(Supervision Company)： 由于 原因，兹提出 工程变更（内 容详见附件），请予以审批。 Due to reasons of , we, hereby, issued variation order for work of (See attachment for detail content), please review and approve it. 附件Attachment： 提出单位（章）： 负责人（签字）： 日期： Issued by (Chop) Responsible person (Signature) Date
一致意见Agreement： 建设单位代表 设计单位代表 项目监理机构 Owner’s Representative Designer’s Representative Supervision Organization 签字： 签字： 签字： Signature: Signature: Signature: 日期： 日期： 日期： Date: Date: Date 注：本表由提出单位填报，有关单位会签，并各存一份；涉及设计变更，尚须由有关单位和人员出具书面的设计变更（或指示）文件。Note: This table shall be filled up and submitted by the party who issues it and
countersigned by related parties, all parties shall keep one copy. In case any design changes are involved, related party and person shall issue document of design change (or instruction) in written form.
洛阳石化工程建设监理公司
Louyang Petrochemical Engineering and Construction Supervision Company（LPECSC）
丽东芳烃项目
LIDONG AROMATIC COMPLEX PROJECT C -- 03
单项（单元）工程： Work Item (Unit): 工程承包单位及承包内容 Construction Contractor Info. And Scope of Contract 项目编号：Project No. 第 页 共 页 Page of 承包商名称 Contractor Name 总承包商 General Contractor 承包合同号 Contract No. 承包内容 Scope of Contract: 分承包商（1）名称 Subcontractor (1) Name 项目经理及资质/上岗证编号 Project manager, its qualification/post certificate no. 分包内容：Scope of Subcontract: 分承包商 Subcontractor 分承包商（2）名称 Subcontractor Name (2) 项目经理及资质/上岗证编号 Project manager, its qualification/post certificate no. 承包内容： Scope of contract:
因篇幅问题不能全部显示，请点此查看更多更全内容