Date :

PT MEMIONTEC INDONESIA FM - MMI - M.005

Page :
PUNCH LIST REPORT
of

Item / Equipment Name : Report No.:

Punch List Category Accepted

Item Target Date
Punch List Description Approved Remarks
No. A or B Date Cleared MMI Client
MMI Client

Note Category Description :

Before : Item shall be corrected before Mechanical Completion
After : Item shall be corrected After Mechanical Completion

Involvement Party MIT CLIENT REPRESENTATIVE

Signature

Name
Date