EASELS PT. ADI WARNA PRATAMA || “SEIS ES EPS As | MAGNETIC PARTICLE INSPECTION REPORT tononer {SUPERIOR ENERGY SERVICES ANPWO Ne. O14/AWPINSTIETS dese “Namanda Towed Flor Sut MD senor No | | JLT Simatupang Kav 23-24 Gllandak Barat Work Location SUPERIOR WORKSHOP eae SENTUL=ROGOR | [ham buxeton ACID CARBOY Tene sev a7 | | esos 3000 GAL-1300GAL____ SOPAWP OOS 82015 | | Seti Number 01 16 0030 002 / ATS 11450 2015. ‘Acceptance Criteria AWS 1.1/0.1 Me2M15,Table 6.1 Monetice “PrGemalaSaranaUpaya =Car specton ‘Febru 13,2009 ‘Scope of Work sction On Weld of Pad Eye lowe seu oe Tovtenion! = mous ex veur® | | fer [cerns oe | | [igor [pk] enna Lo]ematermer Lo]onnwiasin — LJorateinar femmnmin | June Downe Oe ome jeresingzquprent, |] x] Yoke [ x] Medel (94: HAND MAGIA HF 82-1368 arentane eet [unecansary 30 1bs 74.5% [Pale Specie [wena = Continues Method = lov] we LR] wetren areca fanse haere fants > mont [aor ones ag es GWT fsehn ——=a [ser wn nen aptircs /oee tee [erin RECORD / PHOTOGRAPH ‘DIMENSIONAL: tara 207 eM] Twat 207 ewe ert 27M | DDINENSTONALPAD EVE | |Finickness citing [] 2578 ram hk cheek Pad 3641 mam [Hole Diameter 2581 mm INFORMATION LOAD EQUIPMENT [Tare Weight 2,000 Ke Pavioas 6 Ke Max Grose ase] 8.500 [vear aut: JANUARY 2006 IManuscue sa No 01 6000000 [Cert No BV Jakarta = 416025 16-002, Model: GSU-GO1-12-1 | peste: T |_| artore od test [cenasle EE] ei 1 ADL WAR PRATAMA ia aa Lolecsrane FE] reper uetonly Le Jacceptatie (E] repair ater Repair Tolerate EE) ipa seconmendtios: necor ; : manrkaarene Ta npecon HRD Or Based Customers Spee) WERT vl MPT] biting Gear inspector l "EDT WARNA PRATANIA INSPECTIONS(3 PT. ADIWARNA PRATAMA Bes fer sven SEAR PES EPS ASS ESSecae oa CERTIFICATE OF THOROUGH EXAMINATION | | “ha nsatcarene wth ra Obra cLiva Eason fo. ne. OV4AWPINEIKTAE : [see Eariaton 13Feb10 é Repost uae Tes1e0 z = eternce (VL ST€27 2017185 EN 107514550 (ctor an areaes PF SUPEROR ENERGY SERUCES eee ozaton WORKSHOP SUPERIOR SENTUL BOGOR soe Werng Lod, Rajon. MacGroee Was,| Ose arses ‘escpon ad eran ote Cason i psy ste tat Taough Baan AOD CARBO Gi Lan Seg fone a WA No ATS 8602015 fecal Payor = E50 9 Mandaace Sn 0186000002 one oy a saa = 1646002 copaay= tom soo caion |Log sng WW Stace tenance SSN BOF UL Sig = 1457 21090" eee Sra ne = roy 7" WL 8 ON 10 Stasi 1agorar ovens [stairs exer aero ase ase ew te sr? 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AWB 028 / SOP ‘wore Lecston scope of Work: Visual Inspection and Color Coding of iting Set DESCRIPTION Make/Name, Model, Type, Dimension Item Description ACID CARBOY serial Number: ATs 114502015 Dimension 207207270 paviond 6500 Ke Mow 8800 Ke last inapecson + JAN-S.2028 VN By PAdiwarna Prat Manufacture By ‘eae Manufactur FT.GEMALA SARANAUPAYA ani6 RECORD 7 PHOTOGRAPH us tery a Unerined cogent meets, atend rami fig equpmento acer oe wt on an tae earn ‘hewn. The squpen ae ened wth the aspects pee are cra arian pi nd dopo aye Heute | No Found any visual mage atte tin of epecton = Recommendation : (Color Code Uting Gears +6 months) Test nipetion dae 69 UGIST DIOS TFTING GEAR Inspector‘PERIODIC INSPECTION CHECKLIST DAFTAR PERIKGA BERKALA ‘CARGO CARRYING UNITS Refer To : DNVGL.ST-£771 18S EN 120791; 12078:3 PT, Al ADIWARNA PRATAMA ‘Gros ei as) Tre ies avin) atacnre By Dine | LW SUPERIOR ENERGY SERVICES. | ua game ancaersomne gumson VES pce ene lr en ight Ie snes HO, Se and al MA Nac ope (ajnaseonna VAbrsada pad lan ssrig, a tenn Remare/cataan | [besraon of oor co Seat evil pers ape Sebloya 7 estat nd Mg alecu Manafcie Gv ne CU a Pie PS = [ung Cree Seat Ung z ssecton Ga as ot Fes 7 SI or edo gh pce [Tala a ns ip an pa a dgan bn z 1 ae ade Wines asennad Ta in Po wa ae z lady eset / Deter song PE i maxX tomo date sac y Tolbieance adic Pod rac fadee Pad aa Whites 000 [ke teconor Croce tab ade ras waa mi lho Doge, Carona Be Teds bert, Da Wi [pan Stam ie an ns ae age ta Bawah paca itera CCU Tit aeaonar Gest Tad tress Ca wi ‘S[ho mechs Garage Tatas eran ik She Caras cowl or a eat es ore Saar poe cm corer ont Roi Tks avesen c/s oral wie ks Meche Os wi ho avast cn wel ac Tk ds Loreal Sue pa RITE wi io stornaon ch Bot TAs prvatan Dek per Ts on ico Pane tats ho Coos or act ia a cna a ie he Mecho Wi he Corson a we rac ik es Kora Sa pT ik "Ss storsson cen oS Tepes cesar Seva per es Wa [rteine Frome emer Wa Tilpivechnca Soap, caren and bioreactor Dare rs epoca _y [te Peeneldtonped oer Ne Coven and wan wee Ta as ens ia, Wa arsan Wa SCAG | iy [overaConaiton ana Reamimenation ‘nestor cnanatiepean eng alFan arr pete, Goa Far Us Smee Un na ma, nse Weed Rapala Wal land eetee ADIWARNA |! PRATAMA rere Lae ‘PERIODIC INSPECTION CHECKLIST / DAFTAR PERIKSA BERKALA uurtinG SET Reference + OSEN S344 /BS EN 13414-2/ ASEN 13889;2008 [ aesonsciten aersine I Snae creas 05 | sm eras No on Caster: SUEROR EMR SERVES | sve dap tona- 03m stress over fa Sate | sine emer en 22m tng =2960 srossaraseein | Manet 8 Fin eles ‘wokcaon:SUEROR WORES-O STL | Siete ocermente ‘Greve now SeARUSCRUSTAMLESSTEL STONES THE-GxIRTOn Oot | Shc emeton Ne Gouger uta |c507 | eect oy omy | iT Question Fearn 1 he) aemmnmoneantninSsistainiesineenenee re sir chaesexanarrvericbe) | (Yt | Usinnna Aber igen depart Tab knAReeenil | | |, Jessi ati inn ote at Br ela nine | [lee narra nti g aE o Ga ET z (ste |, [im sais aco ar was wma oto ranna Gare ogc aaa Tyg cnt aonen can emanaroaen | yi 1 F we oa ie? | pnees r= saison ad soa inde na ww + [femsosenmetasian wrgureoren dace ont ne eves wegen fen dni nan 18 dt ter? wm | wa rs | wh wa [Bante ee no Tieden au WA [neon FF Use Roar Plesse ec Sing & Soci toe Ud URigSet For Usd) sed Be mss (spc ie Dcatnacle sng Fond rg ep, outa eS Fer Unw Moor vray Urerwaie NIT Rapa aa WF]Lompiran BIO eT. even en aes VISUAL CHECK - PHOTOGRAPH [ ecerpton: ACID CARBOY Det nepacton Foret 13-2019 | Custemer PT SUPERIOR ENERGY SERVICES ‘identification Number: ATS 11450 2015 ‘Customer Address :Alamanda Tower 2nd Floor Suite AD | Dinsioal > 207 207 «770 cm LTB Simatupang Kv 23-2-akara Selatan Manutectre By: Pamala Garaaupaye ‘Work Leeson : SUPERIOR WORKSHOP -SENTUL BOGOR Page: 1072 ‘A [Petre of Data fommtion Foto Date Plt, Marking ‘_ [Petr Sle View ightané Lat TampekSamping Kanan dan Kirt 1, [Petre Botan Ww Tampak Bawah [Remar Inepuctor Nome 1) JAROT SUKRISNO (uation: WIL & UT ATPT LovetLampiran A-GFR- 1-35 PT. ADIV IWARNA PRATAMA l VISUAL CHECK - PHOTOGRAPH coil | Deserinéon: Aci CARBOY Dat Inepeston Fabreary 19-2018 | ‘Customer ;PT SUPERIOR ENERGY SERVICES Iertcation Number: ATS 14802015 Customer Adres :Aamand Toward lor Suite AD | Manutaetre By = PT-emaa Saranupaye LTB Simatupang.Xav23-24 Johar Selon ‘Work Location SUPERIOR WORKSHOP -SENTUL BOGOR Page:20"2 "RP of Data information Fat Data Plate, Maing [Picture Liting Set: Sing And Shackle “Remacts | tnebuctor Mame : i JAROT SUNFESNDPT. ADMARNA PRATAM ww adwemspratns cod FIELD REPORT wesnon Come _PTSLPERIOR ENERGY SERVICES Oelnpaten FEBRUIEY.19-200 er Location Unedesagien 4L£00 SN ___wotunt Ene 2018 uce: Nee Fam By ees See Mk su & NP YIRE ROPE SUNG OW SHACHLE ‘ing Detuson gy Si Wie Rape CW Sasi Satie Sas _ Nonfat CROSBY Tame 5, Mastectin eerd endectver: Rost Tag [at a [te Zam ate le le ast ispeaen Fil Rew o« ‘eo Be Use eS_ PT. GEMALA SARANAUPAYA e of pressure vessel; mining, oil, gas & transport equipment and stee! cutting | MANUFACTURING CERTIFICATE ( Sertifikat Pabrikasi ) | No. 008-2/Cert./QA/GSU/III/16 | This is to certify that the equipment described here in has been inspected : Name of Equipment : ACID CARBOY CAP. 1000-1300 GALLON | Dimension +L. 2.070 mm x W. 2.070 mm x H. 2.700 mm. Quantity 2 Lunit Order No. : 0000030 | Owner Serial No. : ATS 11450 2015 Manufacture Serial No. : 01 16 0030 002 | Customer : PT. SUPERIOR ENERGY SERVICES INDONESIA Painting Colour : Superior energy Blue (Frame) Superior energy grey (Tank) | Max. Gross + 8.500 Kgs Pay Load + 6.500 Kgs | Tare Mass : 2.000 Kgs Manufactured by : PT. GEMALA SARANAUPAYA | Year of Mfg : January 2016 Based on result of the inspection, we conclude that the equipment is in | ready to be for operated and accepted in accordance with inspection procedure of Quality Assurance Department PT. GEMALA SARANAUPAYA. | This inspection were result ACCEPTED and SATISFACTORY. | Jakarta, March 3, 2016 Quality Assurance Dept | Issued by : I ble | (Luna ) | | J.Semper Timur No.3 - Cllincing, Jakarta 14130, INDONESIA Telp.: 021 - 4403068 - 4400526 Fax.: 021 - 4403062: wwCERTIFICATE of Test and Thorough Examination of Lifting Equipment Certificate No. : BVJKT 416025 / 1C-002 Alamanda Buil ‘Name & Address of the Owner: PT. SUPERIOR ENERGY SERVICES INDONESIA ig Suite A-D, 2" Floor JL. TB Simatupang Kav. 23-24, Cilandak Barat, Jakerts 12430 Tel, +62 21 27833500; Fax. +62 21 27833590 Place of Inspection PT. GEMALA SARANAUPAYA Il. Semper Timur No.3 — Semper Cilineing Jakarta 14130, Indonesia Tel. +62 21 440 3068 Fax. +62 21 440 3062 Date of Inspection: February 05, 2016 ‘Maker or Supplier: PT. GEMALA SARANAUPAYA ‘Standard LEN 12079: 2006/DNV 2.7-1 : 2013 and Client Specification ; as ‘Working Load | Proof Load \deatifieation Nos. | Qty Descvipti ing ots Model no. : ACID CARBOY CAP 1000-1300 GALLON $500k | 22,990 kes GSU-901-13-1 ‘All steel construction c/w 4 Lifting Points (MGM) | GPoints) Dimension (LxWxH) : 2070 mm x2,070 mm x2700 mn Mawatociare: Seem ~Test Load @25 xR) : 21,250 kes (required for 4 points) 13,180 kgs ee = Test Load (1.5xR): 12,750 kgs (required for 2 points) ‘and Owner Serial no. : Pad Eyes : 34 mm thickness (1) x 26 mm hole diameter. 13,188 kgs ATS 114502015 LIFTING SET (4 Leg Wire Rope WLL 14,500 kg/set) (Points) Sling Set Serial no. : = 1 Master Link Crosby A347 1-732" PiCno.IMX | 17,000kg iar *4 Legs Kiswire Steel Wire Rope 22.00 mm 14,500 kg @ 30° | *4 Shackles Crosby G2130 7/8” PIC no. 20M 16500 kg/each Shackles Serial ms. : sierra areal, Lifting Test Report. No. BVJKT 416025/LT-02 oe Particle Examination Report Nos. | WAL 610168 "# 0434GBAGSU/MTIV 16 (before lifting test) WAL610149 # 045/GB/GSU/MT/IV/16 (after lifting test) = Dimension Report No. 02/QC/DIMM2016 = Lifting Set Certificate No. WALIC/16/0077 ‘Date of ast Examination [Date of New Examination | Date of ast Proof Load Test_| Date of Next Proof Load Test | I New February 08, 2017 New February 05,2017 Issued at : Jakarta, INDONESIA (On : February 23, 2046. THIS IS TO CERTIFY THAT the above surveyor thoroughly examined the lifting equipment in the above competent ‘mentioned place as per EN 12079 : 2006 & DNV 2.7-1 : 2013 standards and Client Specification. The liabilities & insurance is as er Bureau Veritas General Terms & Conditions of Services.LIFTING TEST REPORT N° BVJKT 416025 /LT-02 ‘Manufacturer : PT. GEMALA SARANAUPAYA Owner : PT. SUPERIOR ENERGY SERVICES INDONESIA Equipment ACID CARBOY CAP 1000-1300 GALLON Model No. : GSU-901-13-1 Manufacturer Serial No. 01 16 0030 002 ATS 11450 2015 ‘Owner Serial No. Dimension (LaWtH) 2,070 mm x 2,070 mm 2,700 mm 8,500 kgs PT. GEMALA SARANAUPAYA, CILINCING, JAKARTA, INDONESIA. 22013 and CLIENT SPECIFICATION. ‘Max Gross Mass (R) Location of inspection BS EN 12079-1 : 2006 / DNV 2.7- Date of inspection 1 FEBRUARY 05, 2016 a SERIAL NUMBER ALL PAD EYES (4 POINTS) | TWO PAD EYES (2 POINTS) Manufacturer Owner Zar (s)] RESULT | 15T(kos)| RESULT 1] 01 160030 002 ATS 114502015 | 21,250 | Acceptable | 12,750 | Acceptable Romar Wael | 5-Feb-2016 ~ Actual Tare Mass : 1,218 kgs: (weighing on Frame only) ~ Lifting Test Performed by : 1) Proof Load applied : ~All pad eyes (2.5 T) +: 22,990 kgs ~ Two pad eyes (1.5) 1 13,180 kgs amd 13,188 kgs 2). Sling angle : 30° to vertical 3) Folding time > 5 mirates 4) Load cell : JCM Scotload (S/N 2050-321 DH3), Capacity : 50 tonnes 5) Lifting Sling Set Serial no. : 16/0077/1-4 ~ Before and after tested, MPE have been carried out with accepted results. ~ Afier tested, the container found no significant permanent deformations Lockman Hakim and free from cracks. SurveyorNSD ‘ld 9O/VO JoA@ans ‘AG fo ea /\M : Gauwdaad |: GaSsaNLIM 9Loz so AuWnuaas b-€b-L06-NS® : TS30OW 00 0€00 9F LO : ‘ON TWIMAS SB ysidi) ditt TWNLOW - SBy OSZ'Zb = sBy 009°8 x $‘L = YUGb= avo1 sby 0098 x gz = uGZ= avo1 shy 00s'8 = ONILWa s6y 009°9 avolAvd “WwNLov - s6y 000°2 LHSISM Sev 0£00000 “ON OM (ADNAN YORadNS' Ld) SNRYVIN NI TIWH'Ld ININ 0022 X O20 X 0202 “NIG NOTIV5 00¢1-0001 dvd AOauvd aiov sbyPT. GEMALA SARANAUPAYA Equipment / Dimension Date of inspection QUALITY CONTROL DEPT FLOe-025 : —_} Lifting Test Data Records Identification number OL 16 0030 OD — 2070 x 2oR0 x 2700 MM Max. gross mass (Rt 8500 igs ‘Actual gs Tare mass (T) 2200 igs ‘Actual = 1216 Cfanut) kes 25xMGM(R) 2 at aso igs Actual: 22-990 igs 1.5xMGM(R) 3-450 ge Actual? w3bo /1818B kgs Standard reference Fen Borg PRI: woOe Locetion of inspection «== _ WO WENMOp PT. CEUALA SAPAKAUPAYA Roary oS! eos. All points lifting Condon wor at a[c[o] es Enos 0 | 40 | x | 20 | 25 Defetons measured beer iting on pos) 1 [30 | wl alo] Defiecions measured daring iting 2 | ag | 4g | 19 | 2. Deecions measured ser iting onpads) "| 3 | x0 | 50] 29 | 28 Permanent deflection (container vloaded) 4 | 20 | 50 | zo | Two points lifting (Diagonally ) Canon Mot AT BY] C|D | & | 4d [*sd| ads| ace Eno 0 | 30 | 50 | 20] 25 4o| 3 | ss | 2s Defcon mearred bore iting on pass) | 1 | 9 | 9 | 20 | 26 40 | w | 5s | 25 Detietons measured during Ing A 2 | | se | 20] os 4o | 30 | 5 | 25 Defleatons measured afer ing on pad) | 3 | 30 | Go | 26 | 26 40 | | @ | 26 Ctenmsnccwcaoriingt | @ [yo | 50 [20 [28] [ao |se | | Defssons meanred cher iting (ompads) | 5 | 30 | BP | 20 | 25 4 | | 59 [25 Permanent deflection (container unloaded) 6 | | | [os ao | % | 55 | 25 ‘Remarks ‘ACWW caRkoy ” MANNOUGH Sm CE or Product Delivered To: Gemala Sarana Upaya, PT 5 Semper Timur No.3 Re O11 Roy Citincing Jkarta Utara Indonesia uustomer (User) Order Number. 0000756-00 D8 ate: Fanvyary 19, 2016 Signature: Put Maxpuatego— Daic of Isvanee David Magnusson, Cosby Quality Assurance Managercoupave writ Ge ciennieo by ow ashy 208 2801 Dawson Rd Tulsa, OK 74110 vwww.sheerasbyaroup com Certificate of Conformance Certificate Number: CC1-2016011900550 Location of Issue: PT Wiguna Artha Lestari Rukan Citta Graha 2-1, JL Panjang Arteri Kedoya No. 26 Jakarta, 11520 Indonesia Phone: 62215 816996 Fax: 62 215-816677 Stock No: 1258182 Description of Gear: _A347_1-7/52" Welded Master Link Assembly ‘Working Load Limit: 37,500 Ibs] [Max. Allowed Proof Load: 93,700 Ibs ‘Comments: Ultimate load is 5 times the WLL Note: Meets or exceeds all requirements of ASME B30.26. Proof tested according to and with fixture sized to prevent localized point loading per ASTM A952 Has not been contaminated by Mercury or Asbestos in the manufacturing process. ‘Number of Pieces: 1 Main Link: IMX Distributor Note: WAL/C/16/0077 PICs are based on visual observation Certificate based on item being the Crosby product described above. We hereby certify that the above described material was manufactured and processed in a manner compatible to meeting the load ratings when used under normal and proper applications. ‘Mentioned products are in conformity to the Crosby literature available at time of manufacturing, including the following trademarked features: + Product Delivered To: Gemala Sarana Upaya, PT 31 Semper Timus No.3 Rr O11 Rw.03 Cilincing Jakarta Utara Indonesia ‘stomer (User) Order Number: 0000756-00 Pal M, = January 19, 2016 Signature a eee ‘Date of Issuance David Magnusson, Crosby Quality Assurance Manager