ENGINEERING, PROCUREMENT, & CONSTRUCTION

TRANSMISSION GAS PIPELINE PROJECT

KONSORSIUM WIKA - RABANA - KELSRI
GRESIK - SEMARANG

WORK INSPECTION REQUEST

To : PT. Pertamina Gas / Representative Request No. : 02/PTG-KWRK/WIR-GNR/I/19/1
Lamongan, East Java Date : 25 Januari 2019
KWRK PIC : RHOMY BN ( 0813-4642-6230 )
PUJO K ( 0812-8948-3466 )
CC : -

DETAIL OF ACTIVITIES
TYPE OF TYPE OF
NO ACTIVITIES TIME LOCATION REMARKS INSPECTOR
REPORT INSPECT

1 Punchlist 09.00 - selesai GRE STATION F F RBN

10

11

12

13

14

15

Date of Inspection : 28 Januari 2019 Type of Inspection

Time : 09.00 - selesai A Joint Survey
Place : As per location above B Material Verification / Preparation
C Witnessing of Testing
Type of Report : D Release Hold Point
A Only this Report D Drawing E Visual for NDT
B Inspection Report E Survey Report F Punch List
C Testing Report F Heavy Equipment Report G Final Inspection
H Equipment and Tools Inspection
Attachment (if any)

RESULT/ CONCLUTION (by Employer/ Engineer) :

A Test / Inspection Result Satisfactory D No Objection & Proceed for Next Work
B Test / Inspection Result Unsatisfactory E No Objection with Remark
C Requires Re-Work and or Re-test F __________________________________
If result is B, C, or E, please put the note below :

Prepared / Reviewed by : Reviewed / Approved by :

Konsorsium WRK PERTAGAS Representative / PMC

______________________ ____________________________
Date :25 Januari 2019 Date :