SAT0IL

CERTIFICATE OF THOROUGH EXAMINATION

Thia ^^port compl^^ w^^i tt^ Ufting Eguipnwrt Engitw^

[Dsto of Thorough eocamination: TDate of Repori: Cefiiiicate No:

22-Jun-19 SO.(Mg777WI9

Hama Mdiaas ol empkjyet k artaarn tha Ihoraugli earartettaien teaa matto: Addraaa of pmmlaea at artdctt ttie a
PT. Taka Hydrocore tndooeata
Tagal
Jl Gedebage No. 247, Oaaranten Kidul. Gedebage. Kota Braidung, Jawa Barat 40295
Daacriptlon and ktarrtjficatton of ttta equipment: Sate Working lo Dateof Date oi laat tttorough
(•): manufactum examlnatlon :
1WO LEG CHAIN SUNG VWTH HOOK (ifknown) :
2TONS
SN : THI-CS-01
DLMENSIONAL: 010 MM X LENGTH 1,5 M TataWelgMlB):
SAFE WORKING LOAD : 2 TONS
NIA

MaxGroaaWelglrt

Wdglrt(a|:

Proolloadapptted
(stateunlta) :

VjaualTeatReauh Dimfln&ionfll Chock Nflmfl Plflte Stefnpmfl

Is this ttie first examination after installation or assembly Wfls the examination camed out:
____
atatw^fliteorlocation? s ? mo [7] TES 0 NO D
tf the answer to the above guestion is YE8, has the aquipment beenl
Within an mtarval of 12 montt? YES D NO Ld
installedcorrecUy?
YES M NO M In accofdance wilh an examination achame? YES D NO 0
Aftar tha occuranoa of axcapbonal ctrcumatancfls? YES D NO 0
tdenttflcatkm of any part fomd to hflve a d rt wtrtuti )s or coukd becomfla dan^er to pcfsons and
(tfnonestateNONE)
NONE
Istheaboveadefectwhichisofimminentdangertopersons 'Note-Thisisareportabledefect
la the atve a defect which is not yea but cculd become a danger to pefaona:
YESby:
(IIYESstatethedatebywtien)
Particulars ot eny repeir, renewal ot atteretion rsguited to remedy Ihe datect identlfied abdve:
NONE
Particutara of any toete canied eul aa part oi Ihe sxamination : (If none atate NONE)
NONE
IS THIS EOUIPMENT FIT FOR PURPOSE

Name&QuaHicationa Name of tha pemcn aulhentjcallng Ihia rapcrt: Latest date by which next thorough
teport: must be carried out:

Immanud Ntejeben
Signature:
MTJPT Lav. II, Ct Operational Mgr
Name and addrassof flmptoyercr pereons making and authonttcatmg this raport:
PT. SATOIL
SAT-P-OPR4X6-F1

Jl. Taman Tekno Blok E3/No.10 P (021)7587-0022 E info@satoil.com

BSD-Tangerang 15314 F (021)7587-0048 www.satoit^com
 SAT0IL
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INSPECTION REPORT
Report No. Date of Test Certiflcate Number
2206-40/VI/19/THI 22Jun2019 SO.04/2777A/I/19
Name of equipment owner: Address of premises wfiere test/examination was held :

PT. Taka Hydrocore Indonesia Tegal

Job No. Description of Eguipment dimensional| 0 io mm x length 1,5 m

QTY 1Ea
TWO LEG CHAIN SLING WITH HOOK
SN : THI-CS-01
MANUF WA N/A

Material : Alloy Steel Procedure Reference : ASTME1368

Type of Joint Configuration : N/A Acceptance Standard : BSEN 818-1:1996
Surface Conditon : Smooth TestType: VisualCheck

Picture Of Eguipment:

VISUAL CHECK (OK)

Resuft:

Visually the structures are good condition. During the visual Inspection no found indication in inspected area/Accepted

Name of person making this r Name of the person authenticating this report :
Immanuel Nababan Adrianus Mendrofa /v

10 L
Signature: Signature:
MT/PTLev. II, Cl Operational Mgr
SAT-P-OPR-005-F2