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BERITA ACARA
SERAH TERIMA FILM RADIOGRAPHY
No. : 00 1 /ITBIBAST/GTLG|!!\|2122

Pada Hari Senin, Tanggal Empat Belas , Bulan Maret, Tahun Dua Ribu Dua Puluh Dua
(1,4/8/2A22), telah dilakukan serah terima Film Railiography untuk Proyek PEKERJAAN PEMBANGUNAN
FASILITAS LNG TERM INAL JAWA TIM UR di Terminal Teluk I among yang beralamat di Jl. Raya Tambak Oso Wilangun
Km. 12 Surabaya, dengan perincian sebagai berikut :

JUMLAH FILM TOTAL FILM TOTAL JOINT WELDING

LINE
4" xLO" 4" xt5" { sHEEr } ORIGINAL
1LNG2.1O.A1B-PU177 SHEET 12 OF 13 0 13 13 5 JOINT

1LNG2-10-A1.5-PU171 48 18 66 22 JOINT

2LNG3-6"-A1B-PU 165 & 2LNG5-6"-

175 0 175 60 JOINT
A1B-PU165 SHEET 1 OF 1

2LNG12-6''-A1D-PU165 SHEET 1, OF 2 1_47 0 147 52 JOINT

2LNG12-6''-A1D-PU165 SHEET 2 OF 2 130 0 130 49 JOINT

2LNG16-6''-A1D-PU165 SHEET 1 OF 1 86 0 86 38 JOINT

2LNG24-2"-AID-PU127 SHEET 1OF 1. 67 0 67 33 JOINT

2LNG33-2,5"-A1D-PU140 & 2LNG34-

90 0 90 45 JOINT
2,5"-A]-D-PU14O SHEET 1 OF 1

3LNG]".6''-41D.PU165 SHEET 1OF 2 62 0 62 24 JOINT

3LNG1-6''.A1D.PU165 SHEET 2 AF 7 110 0 110 38 JOINT

s
31NG2.6"-A1D-PU165 SHEET 1. OF 2 47 0 47 17 JOINT

31NG2.6"-A1D-PU165 SHEET 2 OF 2 46 0 46 16 JOINT

3LNG5-4"-A1D-PU152 SHEET 1OF 1 57 0 57 19 JOINT

3LNG6-4"-A1D-PU152 SHEET 1 OF 1 54 0 54 18 JOINT

3LNG7.4''.A1D.PU152 SHEET 1 OF 1 54 0 54 18 JOINT

3LNG8-4''-A1D-PU152 SHEET 1. OF 1 55 0 55 19 JOINT

3LNG9-4''-A1D-PU152 SHEET 1OF 1 57 0 57 2l JOINT

3LNG].0.4''.A1D.PU152 SHEET 1 OF 1 60 0 60 2l JOINT

3LNG11-4"-A1D-PU152 SHEET 1 OF 1 58 0 58 20 JOINT

3LNG]"2-4''.41D-PU152 SHEET 1 OF 1 58 0 58 20 JOINT

n

A
3LNG]"3-3''.A1D.PU14O SHEET 1 OF 1 31 0 31 12 JOINT

3LNG14-3''-A1D-PU14O SHEET 1 OF 1 30 0 30 ll JOINT

3LNG].5.3''.A1D-PU14O SHEET 1 OF 1 30 0 30 ll JOINT

3LNG16-3''-A1D-PU14O SHEET 1 OF 1 30 0 30 ll JOINT

3LNG17.3".A1D.PU14O SHEET 1 OF 1 30 0 30 ll JOINT

3LNG18-3''-A1D-PU14O SHEET 1 OF 1 31 0 31 ll JOINT

3LNG19-3''-A1D-PU14O SHEET 1 OF 1 30 0 30 ll JOINT

3LNG2O-3,'.A1D-PU14O SHEET 1 OF 1 30 0 30 LL JOtNT

3LNG21-3".A1D-PU14O SHEET 1OF 1 33 0 33 12IOtNT

3LNG22-3''-A1D.PU14O SHEET 1OF 1 33 0 33 12 JOINT

31NG23.3''.A1D-PU14O SHEET 1 OF 1 30 0 30 ll JOINT

3LNG24-3''-A1D-PU14O SHEET 1 OF 1 32 0 32 12 JOINT

3LNG25-3"-A1D-PU14O SHEET 1 OF 1. 31 0 31 12 JOINT

3LNG26-3''-A1D-PU14O SHEET 1 OF 1 30 0 30 ll JOINT

3LNG27-3''-A1D-PU14O SHEET 1 OF 1 30 0 30 ll lotNT

31NG28.3''-A1D-PU14O SHEET 1 OF 1 30 0 30 ll JOINT

24LNGO1-8"-A1B.PU165 SHEET 1 OF 4 0 106 106 36 JOINT

24LNGO1.8''-A1B-PU165 SHEET 2 OF 4 1,6 60 76 28 JOINT

z4LNGO1-8''-A1B-PU165 SHEET 3 OF 4 20 18 38 16 JOINT

24LNGO1-8''-A1B-PU165 SHEET 4 AF 4 0 42 42 14 JOINT

24LNGO2-3,'-A1B-PU14O SHEET 1OF 1 39 0 39 14 JOINT

,d
24LNGO3-3"-A1B-PU14O SHEET 1OF 1 40 0 4A 15 JOINT

24LNG04-3"-A1B-PU140 SHEET 10F 1 4t 0 4t 16 JOINT

2NGt--4"-A1B & 2NG2-4"-ALB & 4NG8-

66 0 66 23 JOINT
6''.A]"8 SHEET 1OF 1

3NG3-12''-D2D SHEET 1 OF 3 77 53 130 40 JOINT

3NG3-12''-D2D SHEET 2 OF 3 69 83 152 48 JOINT

3NG3-12''-D2D SHEET 3 OF 3 30 64 94 26 JOINT

3NG4-6"-A1D & 3NG12-6"-Al"D &

79 0 79 27 JOINT
3NG13-6"-A1D SHEET 1OF 1

3NG5-6"-A1D & 3NG14-6"-41D &

B4 0 84 30 JOINT
3NG15-6"-A1D SHEET 1OF 1

3NG6-6"-A1D & 3NG16-6"-A1D &

72 0 72 26 JOINT
3NG]"7.6''.A1D SHEET 1 OF 1

3NG7-6"-A1D & 3NG18-6"-ALD &

7A 0 70 24 JOINT
3NG19.6''.A1D SHEET 1 OF 1

\*d
3NG8-6"-A1D & 3NG20-6"-A1D &
84 0 84 28 JOINT
3NG21-6''-A1D SHEET 1 OF 1

3N9-6"-A1D & 3NG22-6",41D &

84 0 84 30 JOINT
3NG23-6"-A1D SHEET 1 OF 1

3NG10-6"-A1D & 3NG24-6"-A1D &

91 0 81 29 JOINT
3NG25.6".A1D SHEET 1 OF 1

3NG11-6"-A1D & 3NG26-6"-A1D &

72 0 72 26 JOINT
3NG27-6''-A1D SHEET 1 OF 1

3NG34-12"/4"-D2D SHEET 1 OF 1 21 28 49 14 JOINT

4NG4.8"-A1B SHEET 1 OF 1 3 63 66 22 JOINT

4NG9-4".D2D-PP SHEET 3" OT 2 77 0 77 26 JOINT

4NG9.4"-D2D-PP SHEET 2OF 2 85 0 85 30 JOINT

24NG01-2"-A1B, 24NG02-2"-A1B &

58 0 58 29 JOINT
24NGO3-2"-A1B SHEET 1 OF 1

24NG04.6".A1B & BOG HEADER SHEET

1,07 0 1.O7 37 JOINT
10F 2

24NG04-6"-A1B SH EET2OF2 102 0 LO2 34 JOINT

24NGO5-4''-A1B SHEET 1 OF 1 54 0 54 18 JOINT

24NGO5-6"-A1B SHEET 1 OF 3 58 0 58 20 JOINT

24NGO5-6".A18 SHEET 2 OF 3 106 0 106 37 JOINT

24NGO5-6"-A1B SHEET 3 OF 3 69 0 69 23 JOINT

4NIO1-2"-C2B SHEET l OF 2
&
48 0 48 24 JOINT
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3BD1-6''-A1B & 2'' METERING
134 0 134 65 JOINT
BLOWDOWN SHEET 1OF 1

3BD3-314"-ALB-PU102 & 3BD4-3/4"-

A1B-PU1O2 & 2''- BLOWDOWN LINE L6 0 1.6 8 JOINT

3E-1A/B-PU114 SHEET 1 OF 1

3BD5-3/4"-A1B-pU102 & 3BD6-3/4"-

AIB-PU1O2 & 2"- BLOWDOWN LINE 1"6 0 16 8 JOINT

3E-2AIB-PU114 SHEET 1 OF 1

3BD7-3/4",A1B-pU 102 & 3BDg-3/4"-

A1B-PU1O2 & 2"- BLOWDOWN LINE 19 0 19 9 JOINT

3E-3A/B-PU114 SHEET 1OF 1

38D1"0-314"-A1B-PU102 & 2"-

BLOWDOWN LINE 3E-4A/B-PU 114 18 0 L8 9 JOINT

SHEET 1 OF 1

A
38D11.-3 / 4"-A1B-PU L02 & 3B D12-

3/4"-A1B-PU102 & 2"- BLOWDOWN 18 0 18 9 JOINT

LrNE 3E-5A/B-PU114 SHEET 1 OF 1

3BDt3-3 / 4"-A1B-PU 102 & 38D14-

3/4"-41" B-PU 1O2 & 2" - BLOWDOWN 18 0 18 9 JOINT

LINE 3E-6A/B-PU114 SHEET 1 OF 1

38D15-3/4"-41B-PU 102 & 3 BD16-

3 / 4" - AIB-P U1O2 & 2" - B LOWDOWN 18 0 18 9 JOINT

LrNE 3E-7AIB-PU114 SHEET 1 OF 1

38D17 -3 / 4"-A1B-PU 102 & 3 BD18-

3/4"-A1 B-PU L02 & 2" - BLOWDOWN 18 0 18 9 JOINT

LrNE 3E-8A/B-PU114 SHEET 1 OF 1

48D1-2"-ALB & 4BD2-2"-A1B-PU127 &

18 18 36 15 JOINT
4BD3-8''-A1B-PU152 SHEET 1 OF 1

4BD4-8''-A1B-PU165 SHEET 1 OF 1 40 78 118 42 JOINT

4BD5-8"-A1B-PU152 SHEET 1, OF 2 15 66 81 27 JOINT

4BD5-8"-ALB-PU15
13 88 101 35 JOINT
PU152 SHEET 2 OF 2

48D11-8''-A1B SHEET 1OF 1 0 28 28 10 JOINT

48D1.2-2"-A1B SHEET 1, OF 2 62 0 62 3l JOINT

48D12-2"-A1B SHEET 2 OF 2 40 0 40 20 JOINT

4BD13-1"-A1B SHEET 10F 2 2 0 2 l JOINT

ffi
48DL4-4" - A1B-P U 140 & 48D15-4"-

A1B-PU140 & 48D16-4"-A1B-PU 140 69 0 69 25 JOINT

SHEET 1 OF 1

248D01-6"-A18, 24BD02-6"-Al,B,
66 0 66 22 JOINT
24BDO3-6"-A1B SHEET 1 OF 1

5FW]..8"-B2B SHEET 1OF 1 L4 0 1.4 5 JOINT

5FW2-8".828 SHEET 1. OF 2 30 20 50 19 iOINT

5FW2-8''-B2B SHEET 2 OF 2 38 9 47 15 JOINT

5FW2-8"-B2B t FILLtNG STATTON )

27 0 27 9 JOINT
SHEET 2A AI 2

5FW4-8''-B2B SHEET 1 OF 1 58 6 64 22 JOINT

5FW5-8"-B2B SHEET 1 OF 1 4 6 10 4 JOINT

5RW6-2"-E28, 5RW5-2"-E2B & 5RW4-

16 0 16 8 JOINT
7"E28 SHEET 1OF 3

5RW6-2''-E2B SHEET 2 OF 3 6 0 6 3 JOINT

n
 PT. GT LADANG TEKNIK& PT. PGAS SOLUTI,)N, telah melakukan pemeriksaan terhadap semua
Film Radiography Test untuk Proyek Pekerjaan Pe mbangunan Fasilitas LNG Terminal Jawa Timur di
TerminalTeluk Lamong tersebut dengan kondisi bair dan lengkap.

Demikian berita acara ini dibuat dan untuk d,pergunakan sebagaimana mestinya

Gresik, t4 Maret 2022

Diserahkan Oleh Diterima Oleh

PT. INSPEKSI TEKNIK BERSAMA PT, GT LADANG TEKNIK

TNSPEKSI
TEKh,IIK

E BERSAMA

GUNAWAN ARIWI

Mengetahui

PT. PGAS SOLUTION N-PMO

4"

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