PT PETROKIMIA GRESIK(PKG)

GRESIK, EAST JAVA

Wuhuan
Eng. Co.,
Ltd

REVAMP OF PHOSPHORIC ACID

PLANT PROJECT

Project No.

12057

No :12057-PC70-1312057-60000CV-A20-02

Concrete pouring requisition record

Unit name

SA - Unit

Subcontractor

PT Marga Bangun Persada

Pouring location

T-1303 wall & beams elv.

-0.150 up to 4.000

Concrete specification

Fc 35 N/mm2 + Silica Fumes 5 %

Concrete supplier

PT Karya Inter Nusa

Plan pouring time

WBS No.

December 28 , 2013

Apply concrete
amount (m3)

52 m3

Concrete strength

fc= 35 N/mm2

Pouring proposer

Fendhy Riswanto

According toConstruction drawing FOUNDATION T-1303 IN SA UNIT

Quality engineer

Pre-concrete check item

(Subcontractor)

Remark

1Concealment checkYES NO
2Water and electricity embeddedYES NO
3Construction arrangementYES NO
4Construction equipment prepareYES NO

Approve conclusion Agree pouring

After self-rectification then pouring

Disagree and requisition after Self-rectification

Representatives
Owner
Contractor
Subcontractor

Name & signature

Date