Nindya Karya Buildi n g, 4 th Floor, Suite 407 Jl. MT . H a r y o n o , K a v . 2 2 C a a n g !

Ja" a r t a # $ % $ 0 &hone ' %2 2# (0( ( $7) 4 Fa* ' %2 2# (0 ( ( $%7# valar+i,valar+i.-o. .valar+i.-o.

REPORT of INSPECTION
No. /M- CR/VL/ /20

THIS IS TO REPORT that the MOBILE CRANE has be e n inspec t e d and found satisfact o ril in co!plianc e "ith the applicable Code # Stan d a r d and O"ner Specification re$uire ! e n t s % O&NER # 'SER LOCATION SERIAL NO( # TA)( NO( MAN'*ACT'RER MAN'*ACT'RE SERIAL NO( T+PE &IRE ROPE CABLE MO,EL
BOOM LENGTH M) WORKING DEGREE ( o )

% % % % % % % %
WORKING RADIUS (M) MAXIMUM WORKING LOAD (TON) MAIN HOIST AUXILIAR HOIST

+EAR of B'ILT # 'SE, ACCEPTE, ,ATE Issue d at ,ate % %

% %

.
Oper a tio n ,irector

Form 1609-F-002 Rev. 0 Form for Mobile Crane Report of Inspection

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------This Report e.ide nc e s that the sur.e report e d therein "as carrie d out in co! plia nc e "ith one or !ore of the Rules/ 0uide s/ sta n d a r d s or other criteria of PT 1ALARBI or of a )o.ern ! e n t Ad!inistra tion of Republic of Indone si a and is issue d solel for the 'se of the Co!pa n / its co! !itt e e s / its client s or other authori2e d entitie s( The 1alidit / applica bilit and interpre t a ti on of the Report is 0o.e rn e d b the Rules and sta nd a r d s of PT 1ALARBI "ho shall re! ai ns the sole 3ud0e there of( Nothin0 cont aine d in this report issue d in publication shall be de e ! e d to relie.e an de si0n e r/ builder/ o"ner/ !an ufa c t ur e r/ seller/ repairer/ opera t or or other entit of an "arra nt e4pre s s or i!plied(