<table>
<colgroup>
<col style="width: 3%" />
<col style="width: 11%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 11%" />
<col style="width: 3%" />
<col style="width: 6%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="12">Subcontractor/Supplier:      </td>
<td colspan="8">Pkg. No.:      </td>
</tr>
<tr class="even">
<td colspan="12">Project Title:      </td>
<td colspan="8">Subcontract/PO No.      </td>
</tr>
<tr class="odd">
<td colspan="6">WPS No./Rev.      </td>
<td colspan="4">Weld No.      </td>
<td colspan="6">Repair No.      </td>
<td colspan="4">NCR No.:      </td>
</tr>
<tr class="even">
<td colspan="20">Repair Instructions:      </td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="9"><strong>     </strong></td>
<td colspan="2"></td>
<td colspan="4"><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="9">Subcontractor/Supplier Signature/Title</td>
<td colspan="2"></td>
<td colspan="4">Date</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20"><strong>WELD RECORD</strong></td>
</tr>
<tr class="even">
<td colspan="2">Weld No.</td>
<td colspan="3">Welder ID No.</td>
<td colspan="4">WPS No./Rev.</td>
<td colspan="2"><p>Excavation</p>
<p>Int./Date</p></td>
<td colspan="3"><p>Root Pass</p>
<p>Electrode</p>
<p>Heat No.</p></td>
<td colspan="4"><p>Cover Pass</p>
<p>Electrode</p>
<p>Heat No.</p></td>
<td colspan="2">Date Comp.</td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td colspan="3">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
<td colspan="3">     </td>
<td colspan="4">     </td>
<td colspan="2">     </td>
</tr>
<tr class="even">
<td colspan="20"><strong>INSPECTION RECORD</strong></td>
</tr>
<tr class="odd">
<td rowspan="2"><p><strong>H</strong></p>
<p><strong>O</strong></p>
<p><strong>L</strong></p>
<p><strong>D</strong></p></td>
<td rowspan="2"><p>Fit-Up Int./</p>
<p>Date</p></td>
<td rowspan="2"><p><strong>H</strong></p>
<p><strong>O</strong></p>
<p><strong>L</strong></p>
<p><strong>D</strong></p></td>
<td colspan="4" rowspan="2"><p>Final Visual</p>
<p>Int./Date</p></td>
<td colspan="13">Non-Destructive Examinations</td>
</tr>
<tr class="even">
<td><p><strong>H</strong></p>
<p><strong>O</strong></p>
<p><strong>L</strong></p>
<p><strong>D</strong></p></td>
<td colspan="2">PT Int./Date</td>
<td><p><strong>H</strong></p>
<p><strong>O</strong></p>
<p><strong>L</strong></p>
<p><strong>D</strong></p></td>
<td colspan="5">RT Int./Date</td>
<td><p><strong>H</strong></p>
<p><strong>O</strong></p>
<p><strong>L</strong></p>
<p><strong>D</strong></p></td>
<td colspan="3"><u>     </u> Int./Date</td>
</tr>
<tr class="odd">
<td></td>
<td>     </td>
<td></td>
<td colspan="4">     </td>
<td></td>
<td colspan="2">     </td>
<td></td>
<td colspan="5">     </td>
<td></td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="20"><p>Comments:</p>
<p>     </p></td>
</tr>
</tbody>
</table>