Commissioning Completion Certificate

Document : 21041-780-01-001
Section : Burner System
ATTACHMENT#6
Plant: Jazan Unit: 11 Part:
Client: Siemens
System: Burner System

Date/Hour of Issue Certificate No.:

The party responsible for commissioning confirms that all commissioning activities detailed below have been
successfully performed.

Description Commissioning activity:

Associated Certificates:

No outstanding items

List of outstanding items Ref. No.:

Remarks:

Contractor NEM Energy b.v Siemens Energy Aramco

Resp. Party
Name
Date
Signature

Copies to:

Page 397 of 514

 List of Outstanding Items
Document : 21041-780-01-001
Section : Burner System

Plant: Jazan Unit: 11 Part:

Client: Siemens
System: Burner System Sheet ___ of ___

Completion
No. Description Remarks
verified by client:

NOTE: Additional pages shall be attached as required. Total number of pages shall be indicated on each page.

Page 398 of 514

 Non Conformity / Corrective Action Report
Document : 21041-780-01-001
Section : Burner System

Order nr.:21041 Project: Jazan Subject:

NCR nr.: rev.:
NCR concerning:
Documents Materials Components Production Organisation

Engineering Commissioning Erection

Description of NCR (add attachments if necessary):

Proposal for corrective action:

1. Accept as is Remarks:
2. Rev./Obtain Documents
3. Reject
4. Repair
5. Other
Third party acceptance required: Yes No Name:
Name: Sign.: Date:
SEND ORIGINAL TO PM

(To fill in by PM) Distribution:

For action For information Copy for Registration
- - QA dept.
-
-

FOR ACTION
Action taken/Remarks:

Acceptance third party Name: Sign.: Date:

Enclosures:
Name: Sign.: Date:
SEND ORIGINAL BACK TO PM

Approval of Corrective Action/Close out NCR

Name: Sign.: Date:
Distribution:
- Site
- QA
-

Page 399 of 514