CONDITION REPORT

Trakindo WO : 8500143191 Reported By : YEREMIA R K

Original WO : Reported Date : 04 Agustus 2021

Checked by
Approved by
Foreman/Supervis : :
Service Head
or

(Name and Signature) (Name and Signature)

SIMS Information
DEALER EQUIPMENT CUSTOMER
CODE J213 NUMBER CAT C15 NAME PT. PLN
TECHNICIAN EQUIPMENT PLTD MALIFUT – HALMAHERA
DATE
08 / 04 / 21 27280
IDENTIFICATION LOCATION
Mo/da/yr UTARA
CATERPILLAR CATERPILLAR INSTRUCTION
MODEL C15 SERIAL NO LXJ03776 INSERT VALVE WORN AND SCRATCH
HOURS 17345 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)
122-7375 GUIDE CYLINDER Yes No WORN
VALVE 24 13 223-7263 HEAD AS
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 : GUIDE VALVE PCR Schedule Hrs :
Comp Serial No / ID : 122-7375 Comp Hours :
Comp Arr / Gp No : Life Remaining :
Mach Hrs Install : Comp New Price :
Mach Hrs Removed : Cost To Repair :
Date Comp Installed : Cost/Hr Remaining :
Date Comp Failed : 04 Agustus 2021
Supporting Documentation Required
# Description Y/N Comments
1 Installation Check List
2 Repair & Maintenance History
3 SOS History
4 Magnetic Plug Inspections
5 ET/VIMS Data
6 TPMS / Payload Data
7 Performance Test Data
8 Others Y PHOTO

Failure Outline:Brief outline of what the Customer report

Bagiandari / Part of :TSD.TEC.SOP.001.R00 1 of 3 Form Number : PSDV.SVTC.FRM.001.R00
 CONDITION REPORT

Customer report Schedule MOH Engine C15 .

Background / Research: Include all observations made during your Failure Analysis investigation including good and bad

After check 122-7375 guide valve found normal worn.

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

VIEW OF

ENGINE C15 (#04)

S/N : LXJ03238

VIEW OF

122-7375 GUIDE VALVE

WAS WORN AND SCRATCH

Bagiandari / Part of :TSD.TEC.SOP.001.R00 2 of 3 Form Number : PSDV.SVTC.FRM.001.R00

 CONDITION REPORT

VIEW OF

122-7375 GUIDE VALVE

WAS NORMAL WORN ON HOLE

Conclusions (What Caused the Failure):Describe the root cause and the sequence of events that caused it.
~

Warranty Decision or Recommendation:Please mark X in only one box below.

Not warranty : X Warranty Accepted : ASA Claim* :

Comments:
*) Application Severity Analysis

Solution to Prevent Reoccurrence:

~ Please maintenance schedule service
~ Please performance schedule TA1 and TA2

Check SIS for Service Letters and Service Magazines related to this failure. AMT history, MIM’s history, Oil sample results,
please attach supporting documents below.

Spv Kit Malifut

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