QUALITY ACCEPTANCE LETTER

REFERENCE NO : 0 JDE NO : 0
PROJECT NAME : COATING SERVICE FOR UNDERGROUND CONTRACT NO : C683633
PIPE ROAD CROSSING LOCATION : 4T-18
OWNER / CLIEN : PT. CHEVRON PACIFIC INDONESIA DATE : 6-Jun-11

SUPERVISION : PT. TRIPATRA FLUOR CONSORTIUM

THIS ACCEPTANCE LETTER IS TO CERTIFY THAT SUBCONTRACTOR HAS COMPLETED THE WORKS AS
MENTIONED BELOW :

SYSTEM : WORK ORDER

JDE NO : 0

SCOPE OF WORK : HIGH TEMPERATURE PIPELINE COATING

(detail inspected area is attached in drawing)

COMPLETION TYPE : 1 PARTIALLY 1 COMPLETE / TURN OVER

(detail inspected area is attached in drawing)

THE FOLLOWING REQUIRED TEST & INSPECTION HAVE BEEN CONDUCTED AS PER APPLICABLE CODES,
STANDARD AND PROJECT SPECIFICATION

1 DESCRIPTION

2 SUMMARY REPORT

3 MONITORING BLASTING COATING

4 REPLICA TAPE INSPECTION REPORT

5 FINAL COATING INSPECTION FAB. SHOP YARD

6 FINAL COATING INSPECTION REPORT & HDT TEST

7 HAND OVER MATERIAL PIPE FINISH COAT IN FAB. SHOP TO FIELD

8 ROAD CROSSING CLEARANCE

9 RESULT ACTIVITY BLASTING & COATING

ALL THE REQUIRED INSPECTION REPORTS & QUALITY DOCUMENT HAVE BEEN ATTACHED IN THIS PACKAGE, CHECKED
AND REVIEW BY ALL PARTIES BELOW :

PREPARED BY, REVIEWED BY, APPROVED BY,

QA - QC NUKOTE INDONESIA QA - QC CPI REPRESENTATIVE QA - QC CPI
APPROVED BY,
QA - QC CPI
 Coating Inspection Report Form -
Holiday Test Report
Costumer : PT. Chevron Pacific Indonesia Date : 18/04/2019
Supervision : PT. SMBR Chevron Coating System : 2.15
: Sleeve Installation for Replace
Contractor : PT. KRS Project Title Clamp 6-24 Inch
: Coating Work on Pipe Sleeve
SR NO : 1282641 Description 6-24 Inch
Location : Water Line Pematang GS to Petani Service Line : Pipe Sleeve 6-24 Inch

Holiday Test
√
Reject Accept
Notes
Holiday Tester
Manufacture
Holiday Test at:
Elcometer 270
Model Digital
Calibrated
√ Yes No - PKM 3750 - 20" - 5 Pairs
Voltage Low Voltage
DFT Thickness 150-325 Micron - PKM 3300 - 20" - 3 Pairs
Standard RPO188 RPO274
COM - SU - 5191 - B - PKM 1600 - 20" - 5 Pairs

- PKM 1050 - 20" - 3 Pairs

- PKM 5500/2850 - 20" - 3 Pairs

Prepared/Operate by KRS QC Check/Witness by SMBR QC

Name : Paskah H. Purba # 3146 Name : Apde # 417478

Date : Date :
 HOLIDAY DETECTION TEST RECORD

Project Name : Sleeve Installation for Replace Clamp 6-24 Inch

Client : PT. Chevron Pacific Indonesia

Pipe Dia. : Pipe Sleeve Diameter 6-24 Inch

Coating
: Interseal, Interthane
Date of Test : 18/04/2019 Material

Equipment Type : HDT DETECTOR ELCOMETER 270 LOW VOLTAGE Manufacture : International

Test Voltages : 67.5 V Refer to : Nace RP 0188

SR NO. : 1282641 Coating : 150 - 325 Micron

Thickness
RESULT RESULT FINAL
NO DESCRIPTION REMARKS
1 ST 2 ND JUDGMENT
1 Pipe Sleeve 20"-SLN-PKM 3750 - 5 Pairs-Pematang GS to Bekasap 20 0 ACCEPTED
ACC AFTER REPAIR

2 0 0 ACCEPTED
Pipe Sleeve 20"-SLN-PKM 3300 - 3 Pairs-Pematang GS to Bekasap

3 Pipe Sleeve 24"-SLN-PKM 1600 - 5 Pairs-Pematang GS to Bekasap 3 0 ACCEPTED ACC AFTER REPAIR

5
4 Pipe Sleeve 24"-SLN-PKM 1050 - 3 Pairs-Pematang GS to Bekasap 0 ACCEPTED ACC AFTER REPAIR

5 Pipe Sleeve 24"-SLN-PKM 5500/2850 - 3 Pairs-Pematang GS to Bekasap 0 0 ACCEPTED

Total 28 0

Examinated by, Witness/Checked By,

KRS QC SMBR QC

Paskah H. Purba #3146 Apde #417478

: Interseal, Interthane

: International

: Nace RP 0188

: 150 - 325 Micron

Holiday Test Photograph (NACE RP-0188)

Holiday Test at PKM 3750-20"-5 Pairs

Holiday Test at PKM 3300-20"-3 Pairs

Holiday Test at PKM 1600-20"-5 Pairs

Holiday Test at PKM 1050-20"-3 Pairs

Holiday Test Photograph (NACE RP-0188)

Holiday Test at PKM 5500/2850-20"-3 Pairs

DFT Check
 RESULT Of BLASTING & COATING ACTIVITY

Project Name : COATING SERVICE FOR UNDERGROUND PIPE ROAD CROSSING

Client : PT. CHEVRON PACIFIC INDONESIA
Location : Coating Shop
Coating Material : Atometal AM-C-I
R/C Location : Area 6/7 FPR Package