COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : FRIDA Sign : Titan black : ton
Location : 18500
Date : #REF!
Status : Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs -
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Snapline 10.8M 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs -

31 HARNESS WIRE UNITRONIC ROLL -
32 HARNESS WIRE IKON ROLL -

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : FRIDA Sign : Titan black : ton
Location : 18500
Date : #REF!
Status : Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs -
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs -

31 HARNESS WIRE UNITRONIC ROLL -
32 HARNESS WIRE IKON ROLL -

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : FRIDA Sign : Titan black : ton
Location : 18500
Date : #REF!
Status : Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs -
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Snapline 10.8M 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL -
32 HARNESS WIRE IKON ROLL -

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : FRIDA Sign : Titan black : ton
Location : 18500
Date : #REF!
Status : Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs -
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Snapline 10.8M 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs -

31 HARNESS WIRE UNITRONIC ROLL -
32 HARNESS WIRE IKON ROLL -

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : FRIDA Sign : Titan black : ton
Location : 18500
Date : #REF!
Status : Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs -
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Snapline 10.8M 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : FRIDA Sign : Titan black : ton
Location : 18500
Date : #REF!
Status : Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs -
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Snapline 10.8M 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : PURBA Sign : Titan black : ton
Location : 18743
Date : #REF!
Status : SLEEP Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs -
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Snapline 10.8M 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : T5 BENDILI Sign : Titan black : ton
Location : BN. PRIMA & BENDILI
Date : #REF!
Status : BLAST & SLEEP Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : T5 BENDILI Sign : Titan black : ton
Location : BN. PRIMA & BENDILI
Date : #REF!
Status : BLAST & SLEEP Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : T5 BENDILI Sign : Titan black : ton
Location : BN. PRIMA & BENDILI
Date : #REF!
Status : BLAST & SLEEP Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : T5 BENDILI Sign : Titan black : ton
Location : BN. PRIMA & BENDILI
Date : #REF!
Status : BLAST & SLEEP Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : T5 BENDILI Sign : Titan black : ton
Location : BN. PRIMA & BENDILI
Date : #REF!
Status : BLAST & SLEEP Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 COAL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : BENDILI Requested by : T5 BENDILI Sign : Titan black : ton
Location : BN. PRIMA & BENDILI
Date : #REF!
Status : BLAST & SLEEP Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Nonel 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs 100
5 1399369 Exel Deto 12M 500 MS pcs 400
6 1374818 Exel Deto 15M 500 MS pcs 100
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 EXEL-TLD 12M 25 MS pcs
12 EXEL-TLD 12M 42 MS pcs
13 EXEL-TLD 12M 100 MS pcs
14 Exel XT 15 M, 500 MS pcs 400
15 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
19 1399278 Exel connectadet 25 MS pcs
20 1399302 Exel connectadet 42 MS pcs 180
21 1399294 Exel connectadet 65 MS pcs
22 1399310 Exel connectadet 100 MS pcs 350
23 1399336 Exel connectadet 150 MS pcs
24 1400266 Exel connectadet 175 MS pcs
25 1400258 Exel connectadet 200 MS pcs
26 1374867 Exel Lead in line 2800M/Roll M/roll
27 UNITRONIC600 15M pcs
28 IKON II 10M
29 IKON II 15M

30 IKON II 20M pcs

31 HARNESS WIRE UNITRONIC ROLL
32 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1
 CO AL FROM INDONESIA

PT. KALTIM PRIMA COAL

Anfo : ton
Cost code : 781S112 Heavy Anfo : ton
Pit : INUL LIGNIT & PINANG SOUTH Requested by : FADLI Sign : Titan black : ton
Location : PINANG SOUTH PANEL 3 18534
Date : 14-Jul-18
Status : BLASTING & SLEEP LOAD Catatan Peminjaman antar lokasi
Kolom A dan E s/d J hanya diisi oleh Pihak user dilapangan (tidak boleh disalin ulang oleh storeman)
Kolom B s/d D diisi oleh storeman berdasarkan data dari lapangan
A B C D E F G H J K
No. SC. Description Unit Satuan Req. Issued Used Returned Qty from pit To pit Balance Requested by Remarks
issue
1 1399245 PENTEX BOOSTER pcs 650
2 527432 Detcord 5Gr. 500M/Roll roll
3 1399351 Exel Deto 6M 500 MS pcs
4 1374826 Exel Deto 9 M 500 MS pcs
5 1399369 Exel Deto 12M 500 MS pcs
6 1374818 Exel Deto 15M 500 MS pcs
7 1399385 Exel Deto 18M 500 MS pcs
8 1399377 Exel Deto 21M 500 MS pcs
9 1399393 Exel Deto 24M 500 MS pcs
10 1374875 Exel surface delay 25 MS pcs
11 1399278 EXEL-TLD 12M 25 MS pcs
12 1399302 EXEL-TLD 12M 42 MS pcs
13 1399310 EXEL-TLD 12M 100 MS pcs
14 1374818 Exel XT 15 M, 500 MS pcs
15 1399393 Exel XT 24 M, 500 MS pcs
16 1399252 Exel Shot shell pcs
17 1399260 Exel Connectadet 9 MS pcs
18 1399286 Exel connectadet 17 MS pcs
20 1399278 Exel connectadet 25 MS ( 10 m) pcs
21 3304201 Exel connectadet 42 MS (10 m) pcs
22 1399302 Exel connectadet 42 MS (12 m) pcs
23 1399294 Exel connectadet 65 MS pcs
24 3304193 Exel connectadet 100 MS (10 m) pcs
25 1399310 Exel connectadet 100 MS (12 m) pcs
26 3329463 Exel connectadet 150 MS (10 m) pcs
27 3304185 Exel connectadet 175 MS (10 m) pcs
28 1400266 Exel connectadet 175 MS (12 m) pcs
29 1400258 Exel connectadet 200 MS pcs
30 1374867 Exel Lead in line 2800M/Roll M/roll
30 3149549 UNITRONIC600 15M pcs 650
31 3149549 UNITRONIC600 20M pcs
32 30255209 IKON II 10M
33 1399252 IKON II 15M
34 2449205 IKON II 20M pcs
35 3150463 HARNESS WIRE UNITRONIC ROLL 200
36 HARNESS WIRE IKON ROLL

Handover of Issued Accessories Handover of Returned Accessories

Name Sgn Name Sgin

Issued by : _____________________ _____________________ Returned by : _____________ ________

Recived by : _____________________ _____________________ Recived by : _____________ _________

Police : _____________________ _____________________ Police : _____________ __________

Date : ___________ Date : ___________

DOC. Refere Revision no. Page no

13-28-kpc 6 1 of 1