‘SOR PROCEDURE - CONSTRUCTION SECURITY MANAGENENT PLAN 43910-DD08-POZEN-070016 ‘Appendix 6, Equipment and Materials Gate Pass In and Out Q woorsra rennca Pegl< 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 [7 tine Washing Bay Passed our rime nameorcompany » OT Altg faa Mondii pate: 28/09 he0 . vemcieummer < By Bio _—_—RaiNo eenteties DATE ARRIVAL/ ETA 98 /osfson. Ref eee Goods/ Equipment enumerated below has been permitted to be taken out from the Site of Consortium Contractor Doosan — HutamaKaryaJawa 910 CFSPP 2 X 1000 MW (References: EHS Procedure Security Management Plan / J910-DD08-POZEN-070016) | SLNo Item Description Quantity Remarks Ac Bi fan a Dehuii Ae S Uni ure (epee “ape gh UGor E bl” Cf ) ) ¢ \ l S$ SUB CONTRACTOR SECURITY of CONSORTIUM DOOSAN HIT HUTAMA KARYA Authorized ‘Authorized Signature wme = digs A aso “Ia bet_B-H OFFICER of CONSORTIUM "n EHS OFFICER of CONSORTIUM. DOOSAN HI HUTAMA KARYA TDOOSAN HI HUTAMAKARYA Autborzed ‘Authorized Signature Wa Sienaune - wen Serena ZGa.pomechon “Je. Civil Engines Name Name EHS CoordinatorDINAS PERHUBUNGAN PROVINSI DKI JAKARTA (KEDAUNG ANGKE) VEHICLE PERIODICAL INSPECTIONAGENCY OF DKI DISTRICT Nomor Kendaraan (eicie Repisraion Hanto}——'-BPS49BCO Nomor Uji Gupecioe Nam) IETLAS1606 “Jenis Kendaraan (repose Verte) » Mobil Barang Bak Tertutup Merek / Tipe (brea! Trpd) DATHATSU /$402ANDA NOMOR, VEHICLE REGISTRA07.117 ao ‘Sertiikoidiberion kepodo: nu m3 sewoldengon Perturon Mota Kasehoton Repu Indones Vaksin Kedua 24 November 2021 SAWANGAN Surat Keterangan Voksinosi COVID-19. > ‘Sertifikat ini diberikon kepode: “Sates teh loka voksnasl COVD-IP untuk dea boomer pertma sexual dengn Prturon Mente Kesehoton Repub indonesia Vaksin Booster Pertama 06 April 2022 Klinik Polres Metro Depok Butuh Bantuan? @‘SCR PROCEDURE - CONSTRUCTION SECURITY MANAGEMENT PLAN .4910-0008-P0ZEN.070016 “Appendix 6, Equipment and Materials Gate Pass In and Out Q woorsva rennca Pegl< . 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 [Fine ‘Washing Bay Passed out[_]rime wameorcompany + PT. Althae tai Mant pate: 28Ag GO VEHICLE NUMBER Ag533 xy Req No fl DATEARRIVAL/ETA + 409/202 ee acces 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 / J910-DD08-POZEN-070016) SILNo Ttem Description ‘Quantity Remarks AC Polyton Pk it : 1h | It & Vai fl ae (ot PE Meth ka. 1k oe a sus conrractor SECURITY of CONSORTIUM DOOSAN HI” HUTAMA KARVA autocad utes ome ath hn ~ Eps Ft OFFICER of CONSORTIUM EHS OFFICER of CONSORTIUM DOOSAN HI HUTAMAKARVA DOOSAN HII HUTAMAKARYA ‘Authorized ‘Authorized Signature E Signature 5 wabeat €OTan pancuma foal Romadhon ‘Jr. Civil Engineer aria yr. Civil Engineer Ces EHS CoordinatorPROVINS! JAWA TENGAH KABUPATEN CILACAP ? 330111300391000e2 :HENDRI CAHYADI ILACAP, 30-03-1997 Gol. Darah :- KAWIN =BURUHHARIAN LEPAS Kewarjanegataan: WNI 10-09-2019 Seriaku “f9gga = SEUMUR HIDUP CILAGAP. 2 ae & ;auopul Jo DIseuopy| H!]qGndey UDJDYesey |48}UeW UDIN}O18q UDBGUEP |ONses Joy JO UORD J 24} Yay B2UDP0990 UF (8LOOLLZ0Zq : al YOIeg) 6L-GIAOD EdaUaZeENSY 40 Sop pig a4) 40} payDUIDIDA Usaq Soy 16/38} SISOP 1NZUN 61-GIAOD ISOUISYDA UDYNYDIIP Yo}a} 2z0z ‘so mdy evep uo @zoz judy ¢o je66uey eped 9890S 6r6E°rq9e9Pe}ZeZPO9 : di Tey ranean ama IdVAHV9 INGN3H oY} Aynued 0} 51 SIY) :Dppdey UDYLEqIP IU! }DIYIES UOlRDUIIZOA 61-GIAOD JO 81091513409 6L-CIAOD IsoulsyDA UDBuDIa}9y JOINS “~