THOROUGH EXAMINATION REPORT

This report complies with the requirements of The Lifting Operations and Lifting Equipment Regulations 1998

Report No. : Color Code : Job No. : Date of Report :

RPT/SPT/LMG/2020/III/000/001 - 13-Jan-2021

Company for whom examination was made: Location of where examination took place:
PT. INDO KAYA ENERGI IKE Workshop
Patria Park Office RK16 D.I Pandjaitan Kavling 5-7 Jl. Lanbau Kampung Lio Baru, Citereup - Bogor
Jakarta Timur

*Key
A B C D E F ND SNCR NF SC
See Non-
Exceptional Other written
Installation 6 Monthly 12 Monthly 5 Yearly No defect conformance Not found Scrapped
circumstance scheme
report

Serial Number Description SWL

IKE-SC21-25 Bolt Type Anchor Shackle 4,75 tonne

IKE-SC21-26
IKE-SC21-27 Manufacturer : 2 Crosby, 2 Gunnebo
IKE-SC21-28 Size : 3/4"

Thorough Examination Examination

Status* Safe to use
Reason for* Date of last Date of this Date of next Scope Findings

B - 8-Jan-2021 8-Jul-2021 VN None ND Yes

Examined in accordance : BS EN 13889 + A1

Name of person who carried out the examination : Rahmad Wahyu Sentosa
Position & Qualification of person who carried out the examination : Inspector - LEEA Diploma Registered: 028696

Signed :

Authenticating by : Nur Falah Kamil

Position : Senior Inspector

Signed :

PT. Survey Inspeksi Audit Pratama Tekindo (SIAPTEK) Form No. F-OPR-SPT-12.7.17 Rev.1
Website: www.siaptek.com | Email: info@siaptek.com
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