"_wrensenve consTaucTiON Sheet 3 of 3 CONSOLIDATED FORMS G95/G96/G97 ‘Contact: Durbar Energy Contract No MR8B104 *Tomporary Works llem No. NR@B104/004 ote Ne LS baa G86 Continued [Permit Certificate - Temporary Works |Folowing the ICE's inspection, Ist below any conrecions or modifications fo be made To the works Jory when al the corrections listed above have been made, shou the ICE sign below: [Checkers Name Checkers Signature Date nterserveTemporaiy Works Authorisation this apples only To Temporary works provided by TeTseNve [The TW, Project Manager and Site Supervisor, undertaking the works are to confirm thatthe permited operation listed in sheet ', together withthe special candtions need, wll be carried out jn compliance wth this Permit Alt son betow) I nterserve TW Name P-Inerserve Project Manager Name snterserve Ste Superisor Name, Permit Handover se BSG hl |Where this Permit is to be utised by a ‘an element of the permanent works using temporary |works provided by others under cur control, Interserve *Equire the permanent works contractor to confirm that they lunderstand the control measures required, that theyre satisfied with the condition ofthe temporary works and lundertake to notify us i the condition changes aptfor they become awere of any deficiencies or defecte with the temporary work }. Interserve Project Manager Name Signature Date lz. sub-Contractor!Contractors Representative Nath ‘Signature Date [Parmit Validity [Vaid from time and date) Valid to (time and date) [Permit to Use/“I Load _[~ _Pour_[~ Strike _[~ Jnload_[~ [Document Control Copies to be issued to: rae 1. Direct labour/Agency labour or subcontractor workforce supervisor [2 Permit iasued by Tech Services Dept then roturn copy to Pormit Originator [Quality Control Requirements - Temporary Works iginalor of the Minimum Quaify Conirol Requirement Site _¢~ Tech Services Dept [Minimum Quality Control Originator Name Signature Date [inspection Log IFoliowing the TWC's inspection ofthe Safe Syster of Work (MS) and Field Checksts, ist below any corrections “heels 28 required) lWhen all the above correctionsimedifications have been made, the TWC and Project Manager must sign below. Joniy then can the work progress frwe ‘Nemo Signature roject Manager Name Reuiscsn) A_ Ao Pirie PUT Ron OG a THe PVE $0 PL Ws GZEN CHECLED Foe THe TRACK PRECCIRE — 1EGEPm ~Db6Buy Om RO Minne OF 4 50st Thee PLATE? a MATEOAL 1S AOE QUATE PILING CONTRACT CE HAS Combidaep, THIS Teele pheceyeks Cre AiTAcHe & A re Are Feo, UK oid PVE So OR sue et AWO BNO Whitmire Ake orbtl See eng