PROJECT / CONTRACT : ELECTRICAL SKPP MIGAS INSPECTION AND Ref.

No :
002/MCC/ILB/KI/TO/I/2014
CERTIFICATION
Client : PT. AUDEX PTE LTD

End User : PT. Jakarta Tank Terminal

ITEMS / SUBJECT TO BE INSPECTED :

ITEM/TAG N
93-LVSB-01

Motor Control Center

See continuation sheet

Yes

No

Contractor :
See continuation sheet

QTY
1

P/o n : Yes

No

(client to manufacturer)

DOCUMENTS OF REFERENCE :
Title
Peraturan Umum Instalasi Listrik

Reference n
PUIL 2000

International Electrotechnical Commissioning

Rev.
0

IEC

NETA
See continuation sheet

Yes

INSPECTION
1. INSPECTION PLACE :
Fasilitas Terminal BBM,Tanjung
Priok-Jakarta Utara
2. INSPECTION DATE :
18 Februari 2014
3. STAGE OF INSPECTION :
Document Review, Site
Inspection, verification and
testing
4. KIND OF INSPECTION :
Migas Inspection and
Certification

Ad E 1601/3 e

No
5 NON CONFORMITIES (NCR) :
NCRs issued during reported period : None
List of outstanding NCRs : None
6. MAIN CONCLUSIONS / REMARKS :
Inspection had been perform for this following:
- Document review
- Site Inspection and verification
- Testing
7. NEXT VISIT SCHEDULED :
-

Approved by
-

Date
-

A.

ATTENDANCE
1.
2.
3.
4.
5.
6.

B.

Asep Jusep
Angga Pambudi.S
Blood Tika
-

PT.Kasnia Inspektindo
PT.Kasnia Inspektindo
PT.Jakarta Tank Terminal

DOCUMENTS REVIEWED
Outstanding document refer to site memo

C.

SITE INSPECTION AND VERIFICATION

Site Inspection and verification of equipments activity described as follows:
o

Check Electrical Equipment at all

Check installation electrical and control system

Result for Site Inspection and verification describe as follows (Electrical Equipment ) :
o

All punchlist refer to site memo.

ATTACHMENT Yes

No

Surveillance performed by :
Name
Inspection Center
Diffusion:

1. KI Office

Ad E 1601/3 e

2. Client

Signature

: PT. Kasnia Inspektindo

3. Manufacturer

4. Migas