ADHI - CNTIC - LAPI JO

DOCUMENT NO :

Owner
Equipment
Location
Reference Drawing

DATE

INSPECTION FOR
CONTROL STATION
:
:
:
:

PT. PLN (Persero)

__________________
__________________
__________________

RESULT
YES
NO

ITEM TO CHECK
1

Load test 50%, 100% and 125%

Travelling run test

Traversing run test

Lifting test

Deflection of girder

Erection By
Weather
Temperature

: __________________
: __________________
: __________________

ACCEPT
DATE
SIGN

6
7
8
9
10
11
12
13
14
Note : (*) Shop test item, For Field test will be done if required

Remarks

PT. ADHIKARYA

Print Name
Signature
Date

PT.PLN (Persero)

REMARKS