‘SCR PROCEDURE - CONSTRUCTION SECURITY MANAGEMENT PLAN .J810-0008-POZEN.0700%6 Appendix 6, Equipment and Materials Gate Pass In and Out 8 INDO RAYA TENAGA He A EQUIPMENT / MATERIAL GATE PASS FOR? JAWA.9&10 (2X 1000 MW) COAL FIRED STEAM POWER PLANT, BANTEN *Please checklist and fill the form in correctly data IN[_] Time: Weshing Bay Passed our] Ytime NAME OF COMPANY ov. Fort hhanas dae: 29. Supt son VEHICLE NUMBER Req No eee i Ref Bee ae DATE ARRIVAL/ ETA Goods/ Equipment enumerated below has been permitted to be taken out from the Site of Consortium Contractor Doosan — HutamaKaryaJawa 9810 CFSPP 2 X 1000 MW (References: EHS Procedure Security Management Plan /3910-DD08-P0ZEN-070016) S.LNo Item Description Quantity Remarks Tamar Rod (lets Fran (lnetage DENY | eK Ys = SUB CONTRACTOR SECURITY of CONSORTIUM DOOSAN HI -HUTAMA KARYA ‘Authorized Authorized _w benef A, Nae ( lel Name Let = OFFICER of CONSORTIUM \ EHS OFFICER of CONSORTIUM DOOSAN HIT HUTAMA KARYA DDOOSAN I -IIUTAMAKARYA | Authorized Signature fe Signature sala Scrnnguwn “a. Civil Engineer Name NameBi uMUM BANTEN PRiA SURAT IZIN M ( Driving Lt Nam. RAHI nA Aiama LINK.’ AF.UNG SAMA SR/ VAG - KOTAy E£30N sd é Tempat : . SERANG gitahir : 1: -07-1979 Tinggi 7com Pekertaan NCEMU! No. SiM 790713230 30 taku git 73-07-2023 GO 06- CR RIZKI Wo PRAKOSO, S.H. S.1X + 78061011aoatot29 seaz00 20pt0-07 RAHMANTULLY vwre.ar-13 0n1292088697 he etangiat Poshas 03 10:23 Clegen- NOOO68D Riwayat Pember Vaksin Covid-19 Covonainc 24200821 RS TKIV KENCANA. ‘oosron2 ‘coronavan 202108961 Poakos 00 1023 Ctegon-W0003680‘SOR PROGEDURE ~ CONSTRUCTION SECURITY MANAGEMENT PLAN J910-D008-POZEN-O7OOTS “Appendix 6. Equipment and Materials Gate Pass In and Out Qrvors rece Pam ic i EQUIPMENT / MATERIAL GATE PASS FORM JAWA.9&:10 (2 X 1000 MW) COAL FIRED STEAM POWER PLANT, BANTEN “Please checklist and fill the form in correctly data ves [_] woning Bay Pos our[, Jim: NAMEOFCOMPANY : PT-Doosan HIV Date 2 Feb 2022 VENICLENUMBER =: Bale? SEI DATEARRIVAL/ETA : @ ‘February 2022 ~~ Goods/ Equipment enumerated below lns been permitted to he taken out from the Site of ‘Consortitin Contractor Doosan ~ HutamaKaryaJawa 9810 CFSPP 2 X 1000 MW (References: BIS Procedure Security Management Plan / 1910-DD08-POZEN-070016) S.LNo Ttem Description ‘Quantity ‘Remarks | 1 [Bridge Peck, Noin Hanger 49 peg | Packing ust Support Ter iorapie a KT pF QT (ee a { ‘SUB CONTRACTOR SECURITY of CONSORTIUM DOOSAN HII - HUTAMA KARYA Authorized ‘Authorized Signature Signature + Name + PURE Gun AOLMY _ E._Medbes OFFICER of CONSORTIUM |S \ EHS OFFICER of CONSORTIUM DOOSAN HIL-HUTAMA KAR) ‘Authorized DOOSAN HI - HUTAMAKARYA. | Authorized | Signature Name