Colocation Application & Equipment CAF Number 0134103/CAF/HCPT/122021

Approval Date 2021/12/06

Installation Form
APPROVED
Survey Date

Revision

SITE NAME TBG * SITE ID TBG * Province * City *

Jatisrono 2 142113109 JAWA TENGAH WONOGIRI

Latitude (Decimal/DMS) * Longitude(Decimal/DMS) Site Type * Tower Type *

*
-7.83467 111.12595 GREEN FIELD SST

Building Height * Tower Hight * Client Contact *

- 52

Client/Operator * Client Site ID * Client Site Name * Contact Phone *

PT. HUTCHISON 3 INDONESIA 610752 JATISRONO 2

1. BTS ANTENNA (RF)

CABLES

Item
E=Exist
Dimensions (mm) Mounting (m) Leg
N=New Height (m) * Quant * Manufacture Model Azim (0) * Quant * Size (") *
LxWxD * (BoomxArm) * (AxBxCxD)
R=Remove

1.1 E 35 3 Agisson DX-1710-2200-65- 1954X155X89 30/200/300 Feederles

19.5i-M

Remarks :

2. MW ANTENNAS (Transmission)

CABLES

Item
E=Exist
N=New Mounting (m) Leg
Height (m) * Quant * Manufacture Model Diameter (m) Azim (0) * Quant * Size (") *
(BoomxArm) * (AxBxCxD)
R=Remove

2.1 E 35 1 Huawei A23S03HAC 0.3 1.25 1 1/4

Remarks :

3. ODU/TMA/RRU

CABLES

Item E=Exist
Dimensions (mm) Mounting (m) Leg
N=New Height (m) * Quant * Manufacture Model Azim (0) * Quant * Size (") *
LxWxD * (BoomxArm) * (AxBxCxD)
R=Remove
3.1 N 34.5 3 Huawei Combiner 354X163X156

3.2 N 35.5 2 Huawei RRU5904 2100 400X300X120

3.3 E 35 1 Huawei RRU 3959A 400X300X100

3.4 E 35 1 Huawei RRU 5904 400X300X150

Remarks :

4. LAND SPACE REQUIREMENTS

* TYPE OF EQUIPMENT : Indoor (Shelter) Outdoor (Cabinet) Other (See Remarks)

* SHELTER/CABINET DIMENSION : Length : Width : Height :

* LAND SPACE DIMENSION : Length : Width :
Layout must be provided
Remarks MARKETING/PLANNING : Remarks ASSET/PROJECT :
Expired CAF 2022/03/06
;

TBG TBG
MARKETING/PLANNING ASSET/PROJECT OPERATOR OPERATOR

Jejen
Date Date 2021/12/06 Date Date