PT.

PERUSAHAAN GAS NEGARA Tbk

WORK INSPECTION REQUEST

Project's Name : PENGADAAN PEKERJAAN PENYALURAN GAS KE CALON PELANGGAN PT SARINAH Tbk
Location : Jakarta Doc No. : WIR-THJ-SRNH-005
Date : 23 Agustus 2021

DETAIL OF ACTIVITIES

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

1 Pembuatan Lubang Kerja 08:00 s/d 17:00 Sarinah Only This Report Akbar

2 Manual Boring 13:00 s/d 17:00 Sarinah Only This Report Akbar

3 Pemasangan Turap 08:00 s/d 17:00 Sarinah Only This Report Dimas

Date of Inspection : 24 Agustus 2021 Type of Inspection

Time : 08:00 s/d 17:00

Place : Sarinah Joint Survey

Material Verification/Preparation

Witnessing of Testing

Release Hold Point

Type of Report Visual for NDT

√ Only This Report Drawing Punch List

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,

Contractor PGN

Date : 23 Agustus 2021

Date : 23 Agustus 2021