WO NO = RDP 25

INSPECTION & TEST PLAN DISCIPLINE = EARTHWORK

Road and Location Minas Infill P01(4C-45), Minas Infill DOCUMENT NO = WUR E-QAC-ITP-EW-019
P02 (2D-83), Minas Infill P03 (8E-53)
LEGEND:
"H" = HOLD POINT " W " = WITNESS INSPECTION " SW " = SPOT WITNESS "P" = PREPARE
"A" = APPROVAL DOCUMENT " R " = REVIEW AND COMMENT " D " = VERIFICATION BY REPORT " IR " = ISSUED REPORT

SIGN

SIGN
QUALITY CONTROL

PHR
RDP

SM
NO ACTIVITY/PROCESS DESCRIPTION QUALITY CONTROL ACTIVITY ACCEPTANCE CRITERIA
PROCEDURE REFERENCE

1.0 DOCUMENT REVIEW Contract Document

1.1 Review all technical specification, drawing, procedures & work instruction Review Service Request AFC Drawing , Client Spec, Contract Document R R R/A
1.2 All tech. spec, procedures, work instruction shall be clarified, understood & implemented Review Scope of Work R R R/A
1.3 Finalise deviation, generate new procedure and work instruction if required Review Drawing , Tech. Spec R R R/A

2.0 SURVEY AND TOPOGRAPHY

2.1 Verification instrument and inspection Review/Calibration certificate Best Practice Valid Calibration Instrument R R R/A
2.2 Survey and stake out location elevation and coordinate Review/Survey report Best Practice IFC Drawing W SW/R R/A
2.3 Stake out survey MudPit Survey Report Best Practice Meet to AFC Drawing SW/R SW/R A

3.0 STAKE OUT PORPOSE WELL PAD & ROAD

3.1 Verification instrument and inspection Review/Calibration certificate Best Practice Valid Calibration Instrument R R R/A
3.2 Survey and stake out location elevation and coordinate Review/Survey report Best Practice IFC Drawing W SW/R R/A

4.0 EARTHWORK

4.1 Clearing & grubbing Inspection Report Best Practice Base on stake out survey SW SW/R SW
4.2 Quality of Soil filling Laboratory Test Report Laboratory Test Acceptable/approved material ( Soil Properties ) W SW/R SW
4.3 Soil filling and compaction per layer Visual inspection Base on steak out survey elevation, Filling & compaction per SW W SW
Best Practice
layer thk;30 cm, Compaction test:
-Bettom Layer to Top Layer that >1 meter, Testing per 1
meter
-Bettom Layer -1 meter to Top Layer , Testing per 30 cm
4.4 Density Test ( if any ) Testing Report ASTM D 1556 Min Compaction 90 % of MDD for Pad Area W SW/R SW
Min Compaction 92 % of MDD for Tx-Pad
4.5 DCP Test Testing Report Meet To approved drawing Meet to AFC Drawing (CBR > 6 %) W W SW

5.0 EXCAVATION MUD PIT

5.1 Stake out survey Survey Report Base Practice Meet to AFC Drawing SW/R SW/R A
5.2 Excavation Mud Pit Inspection Report Base Practice Base on stake out survey SW SW/A R/A
5.3 Stability of site protection against earth sliding (Slope angle, sheet pile, etc) Visual Inspection Base Practice SOP Excavation SW SW SW
5.4 Condition excavation bottom (level and cleaning) Visual Inspection Base Practice Level and Clean SW SW SW

6.0 MAINTENANCE CANAL AND INSTALL PIPE CULVERT

6.1 Canal and waterways maintenance Inspection Report Base Practice Meet to AFC Drawing SW SW SW/A
6.2 Install Steel Pipe Culvert size >= 24" diameter Inspection Report SOP Lifting Plan Meet to AFC Drawing SW SW SW/A
 WO NO = RDP 25
INSPECTION & TEST PLAN DISCIPLINE = EARTHWORK
Road and Location Minas Infill P01(4C-45), Minas Infill DOCUMENT NO = WUR E-QAC-ITP-EW-019
P02 (2D-83), Minas Infill P03 (8E-53)
LEGEND:
"H" = HOLD POINT " W " = WITNESS INSPECTION " SW " = SPOT WITNESS "P" = PREPARE
"A" = APPROVAL DOCUMENT " R " = REVIEW AND COMMENT " D " = VERIFICATION BY REPORT " IR " = ISSUED REPORT

SIGN

SIGN
QUALITY CONTROL

PHR
RDP

SM
NO ACTIVITY/PROCESS DESCRIPTION QUALITY CONTROL ACTIVITY ACCEPTANCE CRITERIA
PROCEDURE REFERENCE

7.0 PILING WORK

7.1 Driving Conductor Pipe Pile Driving Record Base Practice ASTM A252 Blows last tree feet base on Request/standart, deviation W/IR SW/R R/A
max 1%
7.2 Driving Rig Structure Pile Driving Record Base Practice Refer to Eng.Design W/IR SW/R R/A

8.0 INSTALL RIG STRUCTURE, CELLAR BOX & HDPE GEOMEMBRANE

8.1 Install Rig Structure Inspection report Drawing, tech. spec's Base on stake out survey SW/IR SW/R SW/A
8.2 Install Cellar Box Inspection report Drawing, tech. spec's Base on stake out survey SW/IR SW/R SW/A
8.3
8.4 Install HDPE Geomembrane Inspection report Drawing, tech. spec's Meet to AFC Drawing W/IR SW/R SW/A

9.0 DISMANTLING WORK

9.1 Dismantling Cellar Box Inspection Report SOP Lifting Plan Clear from Cellar Box SW/IR SW/R SW/A
9.2 Dismantling Rig Structure Inspection Report SOP Lifting Plan Clear from Rig structure SW/IR SW/R SW/A
9.3 Dress up After Rig Release Inspection Report Base Practice Meet to AFC Drawing SW/IR SW/R SW/A

10 WELDING WORKS OF SPLICE PILING AND RSS

10.1 Bevel, Fit Up Visual inspection AWS D1.1 Approved WPS SW SW SW/A
10.2 Weld Profile Visual inspection AWS D1.1 AWS D1.1, WPS SW SW SW/A
10.3 Welder and WPS Review WPS and Certificate AWS D11 Approved by Migas W/R R SW/A

11 Final Inspection
11.1 Punch list and close out Inspection & Report Base Practice All punchlist clear W/P W/R R/A
11.2 Mechanical Completion Review hand over document Base Practice Approved by PHR P R R/A

PREPARED BY, REVIEWED BY, APPROVED BY,

PT.RIFANSI DWI PUTRA QA/QC PT.SM QA/QC PT. PERTAMINA HULU ROKAN
SIGN
SIGN
 WO NO = RDP 25
INSPECTION & TEST PLAN DISCIPLINE = EARTHWORK
Road and Location Minas Infill P01(4C-45), Minas DOCUMENT NO = WUR E-QAC-ITP-EW-019
Infill P02 (2D-83, Minas Infill P03 (8E-53)
LEGEND:
"H" = HOLD POINT " W " = WITNESS INSPECTION " SW " = SPOT WITNESS "P" = PREPARE
"A" = APPROVAL DOCUMENT " R " = REVIEW AND COMMENT " D " = VERIFICATION BY REPORT " IR " = ISSUED REPORT

SIGN

SIGN

SIGN
QUALITY CONTROL QUALITY CONTROL

PHR
RDP

SM
NO ACTIVITY/PROCESS DESCRIPTION ACCEPTANCE CRITERIA
ACTIVITY PROCEDURE REFERENCE

1.0 DOCUMENT REVIEW Contract Document

1.1 Review all technical specification, drawing, procedures & work instruction Review Service Request AFC Drawing , Client Spec, Contract Document R R R/A
1.2 All tech. spec, procedures, work instruction shall be clarified, understood & implemented Review Scope of Work R R R/A
1.3 Finalise deviation, generate new procedure and work instruction if required Review Drawing , Tech. Spec R R R/A

2.0 MATERIAL
2.1 Soil Properties ( if any )
- Aterberg Limit Laboratory Test Report ASTM D 4318 LL max = 40 & PI max = 25 W/IR W/R R/A
- Sieve Analys Laboratory Test Report ASTM D 422 6-inch square passing 100 % W/IR W/R R/A
3/4-inch square passing minimum 70%
- Spesivic Gravity Laboratory Test Report ASTM D 854 -58 W/IR W/R R/A
- Proctor and Mousture Content Laboratory Test Report ASTM D 1557 - 70 W/IR W/R R/A

3.0 STAKE OUT PORPOSE WELL PAD & ROAD

3.1 Verification instrument and inspection Review/Calibration certificate Base Practice Valid Calibration Instrument R R R/A
3.2 Survey and stake out location elevation and coordinate Review/Survey report Base Practice IFC Drawing W SW/R R/A

4.0 EARTHWORK

4.1 Clearing & grubbing Inspection Report Base Practice Base on stake out survey SW SW/R SW
4.2 Quality of Soil filling Laboratory Test Report Laboratory Test Acceptable/approved material ( Soil Properties ) W SW/R SW
4.3 Soil filling and compaction per layer Visual inspection Base on steak out survey elevation, Filling & compaction per SW W SW
Base Practice layer thk;30 cm, Compaction test:
-Bettom Layer to Top Layer that >1 meter, Testing per 1
meter
-Bettom Layer -1 meter to Top Layer , Testing per 30 cm
4.4 Density Test ( if any ) Testing Report ASTM D 1556 Min Compaction 90 % of MDD for Pad Area W SW/R SW
Min Compaction 92 % of MDD for Tx-Pad
4.5 DCP Test Testing Report Meet To approved drawing Meet to AFC Drawing (CBR > 6 %) W W SW

5.0 EXCAVATION MUD PIT

5.1 Stake out survey Survey Report Base Practice Meet to AFC Drawing SW/R SW/R A
5.2 Excavation Mud Pit Inspection Report Base Practice Base on stake out survey SW SW/A R/A
5.3 Stability of site protection against earth sliding (Slope angle, sheet pile, etc) Visual Inspection Base Practice SOP Excavation SW SW SW
5.4 Condition excavation bottom (level and cleaning) Visual Inspection Base Practice Level and Clean SW SW SW

6.0 MAINTENANCE CANAL AND INSTALL PIPE CULVERT

6.1 Canal and waterways maintenance Inspection Report Base Practice Meet to AFC Drawing SW SW SW/A
6.2 Install Steel Pipe Culvert size >= 24" diameter Inspection Report SOP Lifting Plan Meet to AFC Drawing SW SW SW/A
 WO NO = RDP 25
INSPECTION & TEST PLAN DISCIPLINE = EARTHWORK
Road and Location Minas Infill P01(4C-45), Minas DOCUMENT NO = WUR E-QAC-ITP-EW-019
Infill P02 (2D-83, Minas Infill P03 (8E-53)
LEGEND:
"H" = HOLD POINT " W " = WITNESS INSPECTION " SW " = SPOT WITNESS "P" = PREPARE
"A" = APPROVAL DOCUMENT " R " = REVIEW AND COMMENT " D " = VERIFICATION BY REPORT " IR " = ISSUED REPORT

SIGN

SIGN

SIGN
QUALITY CONTROL QUALITY CONTROL

PHR
RDP

SM
NO ACTIVITY/PROCESS DESCRIPTION ACCEPTANCE CRITERIA
ACTIVITY PROCEDURE REFERENCE
 WO NO = RDP 25
INSPECTION & TEST PLAN DISCIPLINE = EARTHWORK
Road and Location Minas Infill P01(4C-45), Minas DOCUMENT NO = WUR E-QAC-ITP-EW-019
Infill P02 (2D-83, Minas Infill P03 (8E-53)
LEGEND:
"H" = HOLD POINT " W " = WITNESS INSPECTION " SW " = SPOT WITNESS "P" = PREPARE
"A" = APPROVAL DOCUMENT " R " = REVIEW AND COMMENT " D " = VERIFICATION BY REPORT " IR " = ISSUED REPORT

SIGN

SIGN

SIGN
QUALITY CONTROL QUALITY CONTROL

PHR
RDP

SM
NO ACTIVITY/PROCESS DESCRIPTION ACCEPTANCE CRITERIA
ACTIVITY PROCEDURE REFERENCE

7.0 PILING WORK

7.1 Driving Conductor Pipe Pile Driving Record Base Practice ASTM A252 Blows last tree feet base on Request/standart, deviation W/IR SW/R R/A
max 1%
7.2 Driving Rig Structure Pile Driving Record Base Practice Refer to Eng.Design W/IR SW/R R/A

8.0 INSTALL RIG STRUCTURE, CELLAR BOX & HDPE GEOMEMBRANE

8.1 Install Rig Structure Inspection report Drawing, tech. spec's Base on stake out survey SW/IR SW/R SW/A
8.2 Install Cellar Box Inspection report Drawing, tech. spec's Base on stake out survey SW/IR SW/R SW/A
8.3 Install HDPE Geomembrane Inspection report Drawing, tech. spec's Meet to AFC Drawing W/IR SW/R SW/A

9.0 DISMANTLING WORK

9.1 Dismantling Cellar Box Inspection Report SOP Lifting Plan Clear from Cellar Box SW/IR SW/R SW/A
9.2 Dismantling Rig Structure Inspection Report SOP Lifting Plan Clear from Rig structure SW/IR SW/R SW/A
9.3 Dress up After Rig Release Inspection Report Base Practice Meet to AFC Drawing SW/IR SW/R SW/A

10 WELDING WORKS OF SPLICE PILING AND RSS

10.1 Bevel, Fit Up Visual inspection AWS D1.1 Approved WPS SW SW SW/A
10.2 Weld Profile Visual inspection AWS D1.1 AWS D1.1, WPS SW SW SW/A
10.3 Welder and WPS Review WPS and Certificate AWS D11 Approved by Migas W/R R SW/A

11 Final Inspection
11.1 Punch list and close out Inspection & Report Base Practice All punchlist clear W/P W/R R/A
11.2 Mechanical Completion Review hand over document Base Practice Approved by PHR P R R/A

PREPARED BY, REVIEWED BY, APPROVED BY,

PT.RIFANSI DWI PUTRA QA/QC PT.SM QA/QC PT. PERTAMINA HULU ROKAN
 Document No :

INSPECTION AND TEST PLAN WUR-QAC-ITP-EW-019

Date:

Issued by Revision: Page:

PT.PERTAMINA HULU ROKAN
QA/QC DEPT.

PT RIFANSI DWI PUTRA

OWNER
PT. PERTAMINA HULU ROKAN

CONTRACT NO.PHR 39PHR20-0091

PROJECT TITLE
Construction Services

Work Unit Rate Package-E Contract No. PHR 39PHR20-0091

Road and Location Minas Infill P01(4C-45), Minas Infill P02 (2D-83, Minas Infill P03 (8E-53)

WO NO : RDP 25

Issued For Review and

0
Approval

Prepared Checked Approved

REV. DATE DESCRIPTION
PT. Rifansi Dwi Putra PT. Singgar Mulia PT.Pertamina Hulu Rokan
 Document No :

WUR-QAC-WP-EW-019
WORK PROCEDURE
Date:

Issued by Revision: Page:

PT.PERTAMINA HULU ROKAN
QA/QC DEPT.

PT RIFANSI DWI PUTRA

OWNER
PT. PERTAMINA HULU ROKAN

CONTRACT NO.PHR 39PHR20-0091

PROJECT TITLE
Construction Services

Work Unit Rate Package-E Contract No. PHR 39PHR20-0091

Road and Location Minas Infill P01(4C-45), Minas Infill P02 (2D-83), Minas Infill P03 (8E-53)

WO NO : RDP 25

Issued For Review and

0
Approval

Prepared Checked Approved

REV. DATE DESCRIPTION
PT. Rifansi Dwi Putra PT. Singgar Mulia PT.Pertamina Hulu Rokan