PT.

ICO ASIAPACIFIC INDONESIA

The Manhattan Square – Mid Tower, 3rd Floor Unit E,
Jl. T. B. Simatupang Kav. 1S, Cilandak Timur, Jakarta Selatan 12560
Tel. 62-21-7884 6938/9, Fax 62-21-7884 7001
Balikpapan Office: Duri Office :
Surabaya Office : Jl. Mandua RT. 04 RW. 18,Kel. Air Jamban 28884,
Komplek Penta No. 59 RT.32 Diamond Park Residance Blok A1/21, Juanda
Kel. Sepinggan,Balikpapan 76115, Tel / Fax No. : +62-542-762996 Duri, Riau Telp / Fax No. : 62-765-598873
Surabaya, Tel / Fax No. : +62-31-99004989

Certificate of Thorough Examination of Lifting Equipments/Offshore Units & associated lifting sets
This report complies with the requirements of the Lifting Operation and Lifting Equipment Regulation 1998

Date of Through Examination: 18 AUGUST 2018 Date of Report: 18 AUGUST 2018 Report No.: 18/0328

Name and Address of Lifting Equipment Owner or Client:

PT. PETRO GAMA INDUSTRI

Description and identification of the equipment and / or lifting set: Date of manufacturing,
CRADLE RACK 4 x 4 - 6 if COC is evident
Equipment Sr. No. MGM WLL Offshore Unit N/A
Offshore Unit 69 1200 Kg. NA Sling Set N/A
Sling Set - NA - Tonne Shackles N/A
1. - NA - Tonne Date of last thorough examination:
2. - NA - Tonne
Shackles
3. - NA - Tonne N/A
4. - NA - Tonne
Was the examination carried out: Visual Inspection ACC
Within an interval of 6 months? YES NO MPI/LPT Result ACC
Within an interval of 12 months? YES NO Load Test Result ACC
In accordance with an examination scheme? YES NO Dimensional check YES
After the occurrence of exceptional circumstances? YES NO Name Plate Stamping YES

Identification of any part found to have a defect which is or could become a danger to person and a description of the defect:
(If none state NONE)
NONE

Is the above defect which is or could be immediate danger to person: YES NO

If Yes, what is the identification and description of the defect above:
Mitigation action required for above defect to restore safe usability of equipment:
-

Any test carried out after any mitigation action stated above:
-

FINAL STATUS OF THOROUGH EXAMINATION OF LIFTING EQUIPMENT: Is the equipment SAFE TO OPERATE? YES NO
Any attachment to this report (State NONE if no attachment.):
INSPECTION REPORT OF : CRADLE RACK 4x4-6, LOAD TESTING

NDT LEVEL II & LIFTING EQUIPMENT INSPECTOR

RISNU ALJUNAY
I - 621005
Date: 18 AUGUST 2018
Latest date by which next thorough examination must be carried out:
AS PER CUSTOMER'S REQUIREMENT.

FORM No. ICO-CORP-OUL-5010 REV.01 Service Category 5

ICO Asiapacific Group - Singapore
EKA
 PT. ICO ASIAPACIFIC INDONESIA
The Manhattan Square – Mid Tower, 3rd Floor Unit E,
Jl. T. B. Simatupang Kav. 1S, Cilandak Timur, Jakarta Selatan 12560
Tel. 62-21-7884 6938/9, Fax 62-21-7884 7001
Duri Office :
Balikpapan Office: Surabaya Office : Jl. Mandua RT. 04 RW. 18,Kel. Air Jamban 28884,
Komplek Penta No. 59 RT.32 Diamond Park Residance Blok A1/21, Juanda Duri, Riau Telp / Fax No. : 62-765-598873
Kel. Sepinggan,Balikpapan 76115, Tel / Fax No. : +62-542-762996 Surabaya, Tel / Fax No. : +62-31-99004989

INSPECTION REPORT FOR OFFSHORE CONTAINER / BASKET / OTHER UNITS

Customer : PT. PETRO GAMA INDUSTRI Report No. : 18/0328 A
Work Location : JABABEKA - CIKARANG Date : 18 AUGUST 2018
P.O. No. : 4522013725 Serial No. : 69
Order By : MR. AGUS ROCHMAD
Description : CRADLE RACK 4 x 4 - 6 Reference Standards
Dimension : 104 (L) X 103 (W) X 208 (H) cm
Inspection Type : Visual Dimensional BS EN 12079-3 EN ISO 23277
: Magnetic Particle inspection Dye penetrant Testing. EN ISO 17637 EN ISO 23278
EN ISO 17638 DNV 2.7-1
EN ISO 3452-1 OTHERS
Area of Inspection : LIFTING MEMBERS ICO Procedure: ICO-CORP-IOP-LE-01

MGM 1,200 kg
TARE MASS 200 kg
PAY LOAD 1,000 kg

WLL min. of Sling Set:

------------7-----------Tonne

A1

D1

B1 B2
W
D2

A2
L
Prev. Thorough examination certificate (TE) / Mfg records (MR)
Date Certificate Number TE / MR
- COC NOT EVIDENT -
PAD EYES (DIMENSIONAL & VISUAL INSPECTION)
#1 #2 #3 #4
Pad Eye Hole Diameter, (DH) mm 22.47 22.37 22.40 22.45
Pad eye Thickness at pin hole, (T) mm 23.76 23.61 23.60 23.58
DH Pad Eye thickness at baseweld, (t) mm 12.83 12.78 12.88 12.47
Bent / Damaged / Corroded (YES / NO) NO NO NO NO
Are the holes cut by Gas Cutting? (YES / NO) NO NO NO NO
Condition of the Weld (ACC / NOT ACC) ACC ACC ACC ACC

t T Note: Pad Eye holes are not to be cut by gas cutting.

Diagonal Distance between Pad eyes D1 1280 mm A1 920

Diagonal Distance between Pad eyes D2 1285 mm A2 920
Are Pad Eyes aligned? YES Y/N B1 920
Pad Eye Ø ≤ 106% of shackle pin Ø? YES Y/N B2 920
Pad eye 'T'/(shackle width 'W') ≥75% YES Y/N
SYSTEM BATCH NUMBER EXPIRY EQUIPMENT SERIAL NUMBER CALIBRATION DUE DATE
Black Ink Dry Powder 4216 OCT 2022 AC Yoke 1403038 27 OCTOBER 2018
White Contrast Paint 7207 FEB 2022 Vernier Caliper 140653219 22 SEPTEMBER 2018
Penetrant - - Permenant Magnet - -
Developer - -
Inspection Results / Comments : Above item was found without any defect at the time of inspection. Acceptable
Note : * Forklift pocket was not provided

* The results of the tool inspection reported by the company to the customer represent good faith opinions only
and are not to be considered classification or usability of tool inspected.
NDT LEVEL II & LIFTING EQUIPMENT INSPECTOR
(Name & Signature) RISNU ALJUNAY

CERT No.: I - 621005

FORM No. ICO-CORP-OCB-5012 REV.01 Service Category 5
ICO Asiapacific Group - Singapore
EKA
 PT. ICO ASIAPACIFIC INDONESIA
The Manhattan Square – Mid Tower, 3rd Floor Unit E,
Jl. T. B. Simatupang Kav. 1S, Cilandak Timur, Jakarta Selatan 12560
Tel. 62-21-7884 6938/9, Fax 62-21-7884 7001
Duri Office :
Balikpapan Office: Surabaya Office : Jl. Mandua RT. 04 RW. 18,Kel. Air Jamban 28884,
Komplek Penta No. 59 RT.32 Diamond Park Residance Blok A1/21, Juanda Duri, Riau Telp / Fax No. : 62-765-598873
Kel. Sepinggan,Balikpapan 76115, Tel / Fax No. : +62-542-762996 Surabaya, Tel / Fax No. : +62-31-99004989

REPORT OF PROOF / LOAD TESTING

Report No.: 18/0328 B Date: 18 AUGUST 2018

OWNER : PT. PETRO GAMA INDUSTRI

LOCATION : JABABEKA - CIKARANG

DESCRIPTION : CRADLE RACK 4 x 4 - 6

SERIAL NO : 69

MAX. GROSS MASS (Kg.) : 1,200

TARE MASS (Kg.) : 200

MAX. PAY LOAD PERMISSIBLE (Kg.) : 1,000

ACTUAL WLL OF LIFTING SET (Tonne) : -

ACTUAL TEST LOAD (Tonne) : 3.01

DURATION (Minutes) : 05

STANDARD : EN 12079-3:2006 DNV 2.7-1:2013

Others AS PER CUSTOMER REQUIREMENT

ICO PROCEDURE No. ICO-CORP-IOP-LE-01

LOAD CELL : Serial No.: 21550 , 50 Tonne

Calibration Due Date: 24 MAY 2019

TEST RESULT : CRADLE RACK 4 x 4 - 6 IS FIT FOR ITS INTENDED USE

REMARKS : LIFTING SET WAS NOT OFFERED FOR INSPECTION

TEST DATE : 18 AUGUST 2018

DETAILS : The Unit has to be used with dedicated

Sling Set - Serial Number -
WLL - Tonne @ - ˚to the vertical
Shackles - Tonne and Serial Numbers -

RISNU ALJUNAY
I - 621005
NDT LEVEL II & LIFTING EQUIPMENT INSPECTOR

FORM No. ICO-CORP-LT-5011 REV.00 Service Category 5

ICO Asiapacific Group - Singapore
EKA