PT.

PERUSAHAAN GAS NEGARA (Persero) Tbk Work

Executor
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WORK INSPECTION REQUEST
Project's Name : Customer Attachment PT MULTI WELINDO Doc No. : 01-WIR/PGAS-MW/X/2018
To : Site Coordinator Area Jakarta Date Tuesday, October 9, 2018
Charles P Bakara PIC : Rantino 0812-8880-3099

DETAIL OF ACTIVITIES

No. Activities Time Location Type of Report Type of Inspect PIC

1 Survey 10:00 - Selesai PT Multi Welindo Bp.Hary H

Date of Inspection : Wednesday, October 10, 2018 Type of Inspection

Time : 10 : 00 - Selesai
Place : Pergudangan 8 - Dadap x Joint Survey
Material Verification/Preparation

Witnessing of Testing
Release Hold Point
Type of Report Visual for NDT
x Only This Report Drawing Punch List
x Inspection Report Survey Report Final Inspection
Testing Report Heavy Equipment Report Equipment and Tools Inspection
Attachment (if any)

RESULT/CONCLUSION (by PGN)

A Test/Inspection Result Satisfactory D No Objection & Proceed for Next Work

B Test/Inspection Result UnSatisfactory E No Objection with Remark

C Requires Re-Work and or Re-Test F

If Result is B, C or E, please put the note below:

Prepared By, Witnessed By,

PT PGAS Solution PGN

Date :
Date Tuesday, October 9, 2018 : DENI