QUALITY CONTROL SURVEILLANCE REPORT

REPORT NUMBER: DATE:

PROJECT NUMBER: PROJECT NAME:

REFERENCE DOCUMENT No. REV. No. REMARKS:

DESCRIPTION OF ACTIVITY BEING MONITORED: SAFETY CLASS SR AQ NSR

LOCATION:

OBSERVATIONS/COMMENTS:

NCR GENERATED: YES NO NCR NUMBER:

INITIATED BY: DATE:

APPROVED BY: DATE:

Bechtel Confidential © 2011 Bechtel Power Corporation. All rights reserved.