FORM EX-02A

Kop Konsultan Kop Kontraktor

Pekerjaan : No. Kontrak :

Kontraktor :

Serial No :
CHECK LIST FOR CANAL / STRUCTURE FOUNDATION
Date/Month/Year : Weather : Fine, Cloudy, Rain
Name of Canal/Structure: Location :

qc value
Average

He

"qc test" should be carried out every 100 m for canal

foundation. (2~3 times/place)
W or as instructed by the Engineer.
He At least 5 times / place for Structure.

Note : Equivalent embankment height (He) should be

He= (W/A)/1.9 calculated in accordance with the scale of the
A (1.9 : Unit Weight of Soil) concrete structure.

Embankment height (He) and Required cone index (qc)

Embankment Required Bearing Required Cone

Remarks Judgment
Height He Capacity qa Index qc

(m) (tf/m2) (kgf/cm2)

Stability analysis Embankment
10 < He m
should be made. Height (He)

6 < He < 10 20 12.5 < qc qc (kgf/cm2)

3 < He < 6 10 5 < qc < 12.5

He < 3 5 2.5 < qc < 5 Acceptable

qc < 2.5 Unsuitable Not acceptable

The above works were carried out in accordance with the checklist mentioned above.

PREPARED AND TESTED BY TECHNICALLY APPROVED BY ACCEPTED BY

CONTRACTOR CONSULTANT PROJECT
DATE SIGN DATE SIGN DATE SIGN

NAME NAME NAME

 Kop Konsultan Kop Kontraktor

Pekerjaan : No. Kontrak :

Kontraktor :

RESULT TEST OF CONE PENETROMETER (CPT)

Package : Date :
Location :
Structure / P. :

Point
No Profil 1 2 3 4 5 qc total Ket
depth (cm) dial qc depth (cm) dial qc depth (cm) dial qc depth (cm) dial qc depth (cm) dial qc

Skets : Catatan: Nilai Konus (qc) = dial x konversi (lbs) x faktor kalibrasi / luas area konus

PREPARED AND TESTED BY TECHNICALLY APPROVED BY ACCEPTED BY

CONTRACTOR CONSULTANT PROJECT
DATE SIGN DATE SIGN DATE SIGN

NAME NAME NAME

I

D 2.1
r 1.05
Area 3.465
Calibration 0.3

II Reading x 0.865 = 1 kgf

III 1 x 6.154 = qc

0.575 / 4.910 = 0.08658

IV Reading x 0.14055 = ……. Qc

 FORM AU-02

KOP KONSULTAN KOP KONTRAKTOR

Pekerjaan : No. Kontrak :

Kontraktor :

Serial No.

INSPECTION RECORD
Date/Month/Year : / / Contractor: PT. Contract No.:
Name of Canal: Inspection Item:

Structure:
CONTROL STANDARD

No./ (1) (2) (3)=

Tolerance Specified Decision Remarks
Point Spec. & Requirement At Field (1)-(2)

Inspected in accordance with : Date of Inspection D/M/Year : / /

FORM: EF-01 FORM: EX-01 FORM: CW-01 FORM:
Name of Inspector Project Consultant
FORM: EF-02 FORM: EX-02 FORM: CW-02 FORM:

FORM: EF-03 FORM: EX-03 FORM: CW-03 FORM:

FORM: EF-04 FORM: EX-04 FORM: CW-04 FORM:

FORM: EF-05 FORM: EX-05 FORM: CW-05 FORM:

FORM: EF-06 FORM: FORM: CW-06 FORM:

FORM: FORM: FORM: FORM:

Sketch/Dimension at Field

10 = 48 qc - 10 = 30 qc - 10 = 80 qc - 10 = 90 qc - 10 = 70 qc -
20 = 80 - 20 = 55 - 20 = 65 - 20 = 20 = 90 -
30 = 70 - 30 = 32 - 30 = 60 - 30 = 30 = 120 -
40 = 60 - 40 = 38 - 40 = 30 - 40 = 40 = 50 -
50 = 55 - 50 = 25 - 50 = 28 - 50 = 50 = 30 -
60 = 70 - 60 = 35 - 60 = 25 - 60 = 60 = 100 -
70 = 80 - 70 = 68 - 70 = 46 - 70 = 70 =
80 = 95 - 80 = 82 - 80 = 62 - 80 = 80 =
90 = 100 - 90 = 100 - 90 = 84 - 90 = 90 =
100 = 100 = 100 = 84 - 100 = 100 =
- - - - -
- - - - -

Decision: A, (Approved and to proceed to next step) or B, Not Approved (to be inspected again)

The Contractor is requested to take necessary action in accordance with decision made above as instructed.
PREPARED AND TESTED BY TECHNICALLY APPROVED BY ACCEPTED BY
CONTRACTOR CONSULTANT PROJECT
DATE SIGN DATE SIGN DATE SIGN

NAME NAME NAME