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OWNER CONTRACTOR

MATERIAL APPROVAL REQUEST


FOR
CIVIL WORK

SUPREME ENERGY RANTAU DEDAP PROJECT


Contract No: # 20000522-OS-10103
DOC No. : RD-BBN01-COW-MDA-3004
REV. No : B Page : 1 of 2
MATERIALS SOURCE APPROVAL REQUEST

Location : SERD -RANTAU DEDAP Month to :


Date : 14 May 2021 Period :

1 Material Name SAVIRCON LIGHTWALL

2 Source of Material BROSUR

3 Manufacturer SAVIRCON MANDIRI INTERNUSA

4 Supplier SAVIRCON MANDIRI INTERNUSA

5 Referensi Drawing

Specification As Attached

Other

6 Specification Recommended

7 Work Location In door INDOOR

Out door

8 Work Item MASONRY & PARTITION WORKS

9 Work Name CONSTRUCTION OF ACCOMMODATION COMPLEX FACILITIES


Apropriate Not Appropriate
10 Drawing :
Consideration of the
Apropriate Not Appropriate
agreement Specification :
Good Fair Bad
Quality :
Acceptance
11 The Material Example Research
Not Acceptance

Permited to be sent to the project


12 Said Material This
Not Permitted to enter the project

Must be done test the quality/Lab


Note
Dimension : 600 mm x 200mm x 100 mm
Submit shop/working to SERD prior to install refer to manufacture standard drawing

SUBCONTRACTOR CONTRACTOR OWNER


Prepared / Inspected by Reviewed/Checked by Approved/Acknowledged by
NAME B AGIE K

SIGNATURE

DATE Abdi M
14-May-21

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