COMPONENT CONDITION REPORT

Trakindo WO : 5646931 Reported By : Abdul Farid / Angga Y.

Original WO : Reported Date : Aug 18 ,2016

Checked by
Approved by
Foreman / : :
Service Head
Supervisor

Tri wibowo Suramto

(Name and Signature) (Name and Signature)

SIMS Information
DEALER EQUIPMENT CUSTOMER
CODE J183 NUMBER DM01 NAME PT.SAPTA INDRA SEJATI
O8 / 18 / 16 TECHNICIAN EQUIPMENT SAMBARATA MINING
DATE IDENTIFICATION I871 LOCATION
OPERATION
CATERPILLAR CATERPILLAR INSTRUCTION
MODEL C15 SERIAL No TEST BLOWBY
HOURS 1634 KILOMETERS

PART NUMBER PART NAME QTY DESC,* GROUP NUMBER GROUP NAME DID THIS INCIDENT DESCRIPTIVE COMMENTS (20
RESPONSIBLE CODE CONTAINING MAKE THE PRODUCT SPACES MAXIMUM PER
PART INOPERABLE INCIDENT)
1000 Yes No INSPECTION
Yes No
Yes No
DESCRIPTION CODES * A – Structural C – Leaks E – System Malfunction G – General Repair K - Serviceability X – Operator
(Refer SIMS Guidelines : B – Surface D – Factory Assembly F – Factory Shipping H – Adjustment N - Abuse Complaint
SEBD0850)

Component Information
Component Description : Mach Hrs Install :
Comp Serial No / ID : Mach Hrs Removed :
Comp Arr / Gp No : PCR Schedule Hrs : Comp Target hrs
Date Comp Installed : Comp Hours : Current hrs failed
Date Comp Failed : Life Remaining : Remain of target life

Supporting Documentation Required

# Description Y/N Comments
1 Installation Check List N Not Available
2 Repair & Maintenance History N Not Available
3 SOS History N Not Available
4 Magnetic Plug Inspections N Not Available
5 ET/VIMS Data N Not Available
6 TPMS / Payload Data N Not Available
7 Performance Test Data N Not Available
8 Others Y TA 1 MACHINE FORM.

Failure Outline: Brief outline of what the Customer reported.

CUSTOMER REQUEST FOR MEASURE BLOW BY PRESSURE

Bagian dari / Part of : TSD.TEC.SOP.001.R00 1 of 4 Form Number : PSDV.SVTC.FRM.001.R00

 COMPONENT CONDITION REPORT

Background / Research: Include all observations made during your Failure Analysis investigation including good and bad.
Machine deliver to our customer PT.SAPTA INDRA SEJATI . The machine was operation at sambarata
site PT. Berau Coal for now with SMU 1634 hours.

Part Number -Name – Modifier Code OBSERVATION

(RH/LH/Upper/Lower etc) To Help Explain Progression/Stage of Failure, Use –
– Notes Identify Type, Amount, Location of Photos/Parts Book Illustration.
Wear, Deposits, Damage, Fractures etc.

Actual condition machine

View Of Engine

Bagian dari / Part of : TSD.TEC.SOP.001.R00 2 of 4 Form Number : PSDV.SVTC.FRM.001.R00

 COMPONENT CONDITION REPORT

View Actual SMU 1634.8 Hours

Shown Result Test Blow By at Load

Spec Range

<810 FT3/HR Acceptable

810 FT3/HR – 1080 FT3/HR Monitor
>1080 FT3/HR Action Required

Conclusions & Suggestion :

Blow by result is in Acceptable Range.
Please keep always perform Engine Maintenance in accordance Operation & Maintenance Procedure
(OMM)

Not warranty : X Warranty Accepted : ASA Claim* :

Comments:
*) Application Severity Analysis

Solution to Prevent Reoccurrence:

Bagian dari / Part of : TSD.TEC.SOP.001.R00 3 of 4 Form Number : PSDV.SVTC.FRM.001.R00

 COMPONENT CONDITION REPORT

Bagian dari / Part of : TSD.TEC.SOP.001.R00 4 of 4 Form Number : PSDV.SVTC.FRM.001.R00