SATOIL CERTIFICATE OF THOROUGH EXAMINATION ‘This per caps wih Ling Ease gers Asin Toei eutornts [uiza 4130 indonesia. Dats Theagh earinaion [past Reeat [ome We ‘onie2a soueezs sooucssanves EBS eG Tt Wa SS AC NW STR [>is ot promises a which the eraminaton was made lp. Superirane ira Vara, [nay Cain Cina N98, RT COS, Kel Sper Barat, Kee: Cin, tata Werkenop PT. Supatone [Description and aniNCaT oT e SRUSRATT TSS Forxit sae Wrng Los leraminatin ne Leg ecarce ‘Sy Worang Lod jos roa en) Sena eer Crceers esmcey este Wwansacue wenn 2.510 | Proctor | ‘cute unt Tetons esto sne os nowdieas. opin nap tetaren crn en ce “Tpe epee Se aa Paar oe wee OATET Tt [Was be eamntin corto sts te tat examination ater instaoton or assonbtyat [Te Toa] cy] fem enmerwtetmenner =lol=la new eo or cater? [renin anne of12 mans? ves | & [no [T} ne snort abo unten s YES ns he gent en pees ws] O] xo] 2 ae fs] [vo [] fn eriton ste o |r tmcccurw decmtanscranstness? | ves |G | xo [ Saas aya Sasa ET a a US SSN Sa OT cre ve HONE) won stm at ect ich itil dagen pons "Note Tea pret =o] ste a a act wich aly ba cad Dane OS] aa (Yes sec wen) Pa ee oto BS TR TSH OS RT TE PaaS a OT os SRST TOME PiReport soauewuaniss 15 TH'S EQUPMENT FIT FOR PURPOSE yes| a [nolo rs AEA) Wi Jur er Lori, LEEA ODE, ABA, ASL IPARIGAS ABAAK3U, foresee Rane Geaicaions ed pasanmaling RS [Vane oe pam aaECaEG MPT [ost ca by wih nt reg a ar24 JL Taman Tekno Blok E3/No.10 BSD ~Tangerang 15314 (021) 7587-0022 F (021) 7587-0048 E info@satoilcom www.satoil.comSATOIL PT. SATOIL ‘Taman Tekno Biok E3/No.10 BSD-Serpong 15314 Telp : 462 21 7587 0022, Fax: +6221 7587 0048 MAGNETIC PARTICLE EXAMINATION REPORT Name & Address of equipment owner Customer: [acoor Naber: Pr Superkrane Mira Utama so.oa/c/aaapuye3 ib Desaroton bate often Marz Desciption of |: Foktte Ecipment ob Location Workshop PT. Supertrane Equipment Type: Ung Appliance lMPtProcedure No. : SAT-P.OPROSE seria Number: cruace2775 Jcceptance Cetera AWSDLI/DLIM; AWS D141 Jou 12,5Ton Joust Requirement: ASTILE700.01 Material Type + carbon Stel Magnetization Techniques + YOKE Welding Process + SMAW Euipment Serial Number surface Preparation: ASWELDED, Wire Brushing, BaseMetal [Magnetization Currents: PERMANENT Metal surface Temp: Ambience Temp. Examination Medium Wer visible ight Meter wa Intenaty: Clear Daylight [Technique + Wet Continous Method Black ight Meter: WA Intensity: WA naaterit Product Manufacture: Batch Not Sx: iting Catbration 10\bsatainehegs Yoke maxctst _|teaner SKS Magnafux 160608 Jun23 Post Cleaning wipe lwite Contras cr? —-Magnalcx 190607 Jun23, Stage Examination + Before oad test IMagneticParticle HF Magnaflex 210203 Feb-2d [Application ‘Spraying Field Meter Brand / strength: WA eld indicator A Residual Meter Brand wa JDemagnetization Process: WA ; Ineation interpretation no] partortsamination | Locaontoine umber | HHO] type otoetect | MEP PUTE | omar Tapper ¥ oa YS Tone Tet Lower ¥ os Ye ene fight Upper ¥ NIA Yes None Fight Lower ¥ mI Yes one * Fork ‘Left Upper ¥ N/A ves ‘None Tet Lower ¥ oa YS None fio oer ¥ WA YS ene Fight Lower Le NI YS None Picture of eulpment: See Atachment [Result of inspectio Visually the structures are in good condition. During the MPI inspection no found indication in inspected area / Accepted ‘Name of person making this report MT/PT Lev Il, LEA, OCE, AKQL, IPA MIGAS, IABA.AKSU, SA tL Reviewed and. raved By = SAT-#-oPR.005-F (Rav.02)SATOIL PT. SATOIL, Taman Tekno Blok E3/No.10 BSD-Serpong 15314 Telp : 462 21 7587 0022, Fax : +62 21 7587 0048 MAGNETIC PARTICLE EXAMINATION REPORT Name & Address of equipment owner/Customer : [Report Number: PT. Superkrane Mitra Utama $0.04/c/a42jin/23 [ob Description 7 ate of Test ‘o-Mar23 Description of Forklift, Farad lob Location SAT-P-OPR-0S6 Equipment Type _: Lifting Appliance NPI Procedure No, (02/SAT/V¥/2010 Rev 01 Serial Number +: ¢F18C82775 Jacceptance Criteria ‘AWS D1.1/D1.1M; AWS 014.1 swe Ton Jouality Requirement: ASTME709-01 PHOTOGRAPH ATTACHMENT Pm | Forklift Name of person making this report ; TOIL Armand Zachary TI PT Lev Il, LEEA, OCE, AKSL, IPA MIGAS, IABAAKSU, ne By Adi Latenrisau Director SAT-P-OPR-005-F2(FEV.2)SATQIL PT. SATOIL, ‘Taman Tekno Blok E3/No.10 BSD-Serpong 15314 ‘Telp : +6221 7587 0022, Fax: +62 21 7587 0048 ws MAGNETIC PARTICLE EXAMINATION REPORT [Name & Address of equipment owner/Customer: Report Number: PT Superkrane Mitra Utama ‘sooajcyaaz/uy/23 Hab Beseaton, Date of Text + Marz3 lovscription of Forklift eaehsnans lob tocation Workshop PT. Superkrane Equipment Type Lifting Appliance MPI Procedure No. ‘SAT-P-OPR-056 Serial Number = cF18C-82775 [Acceptance Criteria AWS DLI/DLAM; AWS 014.1 [sw £2,5Ton [Quality Requirement: ASTMET0S-01 Maternal Type Carbon Stead [Magnetization Techniques + YORE Welding Process: SMAW Equipment Serial Number Surface Preparation : AS-WELDED, Wire Brushing, Base Metal | Magnetization Currents PERMANENT [Metal Surface Temp : Ambience Temp. [Examination Medium Wet Visible ight Meter NA Intensity: clear Davieht Technique Wet Continous Method Black ight Meter: WA Intensty: WA ate roduc Manufacture: Batch No: apie: iting Calibration + 10Ubsatainch egeof Yoke maxcist [Cleaner SKCS Magna 180608 Jun23 Post Cleaning Wine white Contras WCP-2 —Magnafsx 190607 un stage Examination + After Load Test Magnetic Particle 7HF ~——-Magnafx «210703. =Feb-2a Lapptcation soraying iets Meter Brand /Strength : NWA ret indicator A Residval Meter Brand NA Demagnetization Process: N/A : Indeation interpretation ne] raorcuaminion | toetin/ein number | PHT peoteteer | SERN | pemars Teton ¥ Wa Ye Tom Tet Lower 7 Wx ve ene Tight Upper v WA ve Tone Tight Lower 7 WA 1S None : Fork Teft Upper z WA ve Tone Toft Lower 7 WA 1S None ght Upper 7 WA 1S Tone ant Lower 7 WR 1S. one Picture of equipment: See Attachment Result of Inspection : Visually the structures are in good condition. During the MPI inspection no found indication in inspected area / Accepted ‘Name of person making this report 4 ‘Armand Zachary. MT/PT Lev ll, LEEA, OCE, AKSL, IPAMIGAS, IABA,AK3U. SA Reviewed and Approved By "si Latensisau Director SAT-P-oPR005-F2 (Revd)PT. SATOIL ‘Taman Tekno Blok E3INo. 10 BSD-Serpong 15314 ‘Telp : #62 21 7587 0022, Fax: +6221 7587 0048 cone MAGNETIC PARTICLE EXAMINATION REPORT Name & Address of equipment owner/Customer: [Report Number : PT. Superkrane mitra Utama so.o4/c/aazui/23 fab Beseristion 7 Date of Test = SMan23 Description of + Forklift, gulooent: Lob Location ‘SAT-P-OPR-0S6 [Equipment Type _: Lifting Appliance ut Procedure No. = 02/SAT/VI/2010 Rev 01 Serial Number 1 CFLBC277S [Acceptance Criteria = AWSD11/D1.IM; AWSD14.1 swe , STon lcuaity Requirement = ASTME709-01 PHOTOGRAPH ATTACHMENT Forklift ‘Name of person making this report oe J MT/ PT Lev Il, LEEA, OCE, AK3L, IPA MIGAS, IABA,AKSU. ‘SAT-P-OPR-005-72 (€V.2)INSPECTION REPORT @ Interm 5 A ir 0 IL No.SO.04/R/442/N23 O Final Ref: BS 1SO 5057:1993 Project: - Name & Adress of enployer for whom the | inspection : PT. Superk: litra Utama Vendor (Equipment ‘Owner) : PT. § 7 ‘Superkrane Mitra Teepection Requested by PT. Superkrane Mitra Utama, Equipment Description Type Equipment Model Forklift NA FD25ND Capacity Manufacture ‘Year BuiltlUsed 2.5 TON Mitsubishi 2019 ‘SUPPLY / SUBJECT OF INSPECTION ITEM / TAG NrJSerial No. Docume Review, Physically Inspection Destructive Te Visual Inspection, Non CF18C-82775 tEa and Proof Load Test DOCUMENT OF REFERENCE: See continuation sheet for additional documents: LI Yes INO Title Roferonce No. Rov. |___ Approved by Date Cerificate of Thorough 7 ; 10 er eo '$0,04/RU442/1U23 PT. Satoil phe Mitsubishi Heavy Cottiicate Of Origin (MFD-15-0081 : Industries Forkit | 90 Jul2019 (Dalian ) Co.,Ltd. Emmission Gas Test 2023-03-AN-3993-N - ao i Direkrokrat Jencral_ | 10 Feb Centicate OF Migas | 107/S6-225/PA/DMTIZ020] - | grey oraeneal | IES | 31 Aug Certificate Sprak Arrestors a 7 Donaldson pon Maintenance Record : 7 Superkrane 63 Now ‘Manual Book - Mitsubishi : Reference Standard : BS ISO 5057:1983 Doc. No. SAT-P-OPR-005-F9.MA SATOILSAT 0 IL INSPECTION REPORT @ Interm No.SO.04/R/442/1/23. O Final INSPECTIONS: (09 March 2023, WS Superkrane ‘Stene of inspection: Inspection Activities: «© Before manufacturing = Presnspection Mesting f During manufacturing a Wines 8 Final © QC Inspection Packing 5 Quality Audits 1 Factory Acceptance Test (FAT) Type of inspection: 2 Site Acceptance Test (SAT) 5 Others 4 New ingpoction 5 Existing inspection bi a 21. CM 1 5, Mechanical Retating Pactquip, Critical: 22. Piping 2 Process = Rating 1 Rating 3 53. Prpoine [rT and Telecommunication Rating 2 Rating 4 oa eal mothers, Fork it © 5. Mechanical Static ‘Stamping: Doc. to. SAT-P-OPR-005-F9.MA gat oeNo.SO.04/R/442/1/23 O Final SAT 0 IL INSPECTION REPORT @ Interm l Resuit of inspection: Satisfactory Unsatisfactory (include NCR Number where required): NA SSSR taved dag rote prod WA © ListoFoutstanding NCR's : WA Main Conclusions and Remarks: for details see continuation sheet) ‘Satisfactory Nest vai scheduled: N/A Description of the inspection carried out (Al the following fields should be filled out) + Attendees: = Armand Zachary Applicable Documents & Status Approval (List down the type of documents reviewed & endorsed) + Cettificate of Thorough Examination + Cottiticate OF Origin = Emmission Gas Test = Certificate OF Migas = Cerificate Sprak Arrestors = Maintenance Record = Manual Book Manufacturing Progress Status (Complete. On-going, % completion) = Completed Dotalts of inspection activities carried out with respect to scope of work. (Please describe the type of inspection carried out on the below space) = Document Review = Physically Inspection / Visual Inspection = Non Destructive Test = Proof Load Test Result of inspection: = Accepted Inspection Finding: - None Date of issue: 10 march 2023 | lnspection center: WS. Superkrane Distribution: EICLIENT [CO MANUFACTURER: Doc. No. SAT-P-OPR-005-F9.MAINSPECTION REPORT @ Interm s A T 0 | L No.SO.04/R/442//23 {2 Final annex ocumenTs REE 0 erxcnoNTEn DOGTMERTS | ew RESULT 7 Certificate of Thorough Examination Yes Accepted & Certificate Of Origin Yes Accepted 3 Emmission Gas Test Yes Accepted 4 | ete OF Niges Yes = s Certificate Sprak Arrestors Yes Accepted | [6] Maintenance Record’ Yes ‘Accepted | 7 Manual Book Yes ‘Accepted — ‘sua. misemcnon poet wo TNePECTION TEM 7 — —] werecnow nesuct 1 Inside Cabin Yes Accepted 3p ana Yer | 3 Tyre condition and reserve Yes Accepted 4 Engine and transmission group Yes Accepted 5 | Rotary and lamps function Yes [Accepted Tangerang Selatan, 10 March 2023 SAT ZIL { Armand Zachary) Doc. to. SAT-P-OPR-005-F9.MASATOQIL INSPECTION REPORT No.SO.04/R/442/1/23 @ Interm O Final Doc. No. SAT-P-OPR-005-F9.MA,SATOIL| INSPECTION REPORT a Interm | No.SO.04/R/442/1/23 O Final ‘Photoghrapic details ™ SF: Ss View of Inside Cabin View of Emergency Stop View of Spark Arrestor Doc. io. SAT-P-OPR-O05-F9.MA SATOIULINSPECTION REPORT No.SO.04/R/442/123. @ Interm O Final Photoghrapic details View of Machine And Battery Doc. No. SAT-P-OPR-005-F9.MAINSPECTION REPORT @ Interm s AT 0 I L | No.SO.04/RI442/23 O Final Photoghrapic details Doc. No. SAT-P-OPR-O05-F9.MAINSPECTION REPORT @ Interm Ss AT 0 IL No.SO.04/R/442/23 O Final | CERTIFICATE OF | ORIGIN sat Nt Doc. No. SAT-P-OPR-005-F9.MAMITSUBISHI HEAVY INDUSTRIES FORKLIFT(DALIAN) CO.LTO. vom vgs sus a soe ss a ‘at acon 2018 Meo EF NO. ro 18-006 TO WHOM” MAY CONCERN CERTIFICATE OF ORIGIN Vie hereby certily Lua ful aweig guuds have Leen manutactured in China’ by MITSUBISH! HEAVY INDUSTRIES FORKLIFT(OALIAN) GO.LTD. DESCRIPTION SUTEEN 16) UMTS OF MET EURIGH! FORME Tove unais rotti ZSiWe GYC O LMD WS". ACR Wak 10. ‘oe Unt raven srPa0. SVK S¥e.3 LIBID Pee ACR PART FOO. Five's) wars FOIOAT 2FPaD YR. 310 LIO7D FS:PS ACAIT PARTE TOOL TWEE “Urs “bash agPa0 CyB/O Lose 8-Hs. Ad Haren. Tam One an ORK TEND OVD IW PA ane ToOL Two i ners roan PRG ENE HRD is 1g acer Pat TAM One runt votant ue av8 Gye Bitov0 vs soar Paar TOO ‘OME "11 UR FORSN AFPQO C¥o/D'LIOPG Pong ACKIT PARTE, TOOL eras rT we me stan ssea9 Forow oF 86 so1as sas te ett Fomouo CF so-s0150 Sas Paty Fomut —€F 80 30151 ‘545 398203 Beast Fost Ss tow, fe Metdarhgeaes osu Sissuaiat 1 stores Fost Bene 1 stn toes Foamt as Sens 1 igor 1987 Fost 45-398 ato? 1205 Fast Sass fa sina rosso Bas ae He stgartaa5 Fousno 545-3369 ean 9998 roe 45 3152 (ta a Fomud —Gers-aniis~ Sas aed Io sn 418s Fomuo —cr'sc-aniie Sasa? eee Foam Ge sonar ene TsuR 9H wEAvY MOUSTES FORKLIFT BAAN 60.4e900 weyrivaissmwos SaReLSTON ASH MEINEM Sscu0tt sr weer 4 2 anweus eanee-Se8 ouze-op. 39 Oizo since 505 ‘nea erect Se Guiza fc gs esos, ‘iieas Sec-et/zsi-n suber ses urea feccet eet Seance sts, uee-o8.29 eas zoe S65 Woo ri teas " ott SS 908. 3r10 ante “ cee-SHS on-3iso Iutead seeeet/bsLan cance Se8 ‘eto 99.49 Nea fin a teovee-sre oploe-on 39 reas fein subs Ses frioe ona sevad ees pst TS OnE REO OO —— EET stvi30 oo ahve LOY S¥Sd OUOFT O1940 OCU UAGEOL LNA BNO Nook HAV ID Set St 0:01 Q-O80 AC FelsE INEZOY HME NO °C inva mow str sn gto Y QA Daa wee tne 2) Ott “WoG1 BUNS. LOY Sa Se OL017 G’O19 Orde AVGROS LNT 3H IGoL wiawe ing Se Se 90011 G/OAD OegSe CheTO= NT IHRM Yoo Buta INOW Ses O01 G98 NAB ORasEL8GC0) Uns 3A Noo: Einva uNOW. Sata WUBIN C°DAD MAP Dede nNEeA LIN I ToeH Bi IHOY SA'SA BOLD 1-319 Oeasz MEY SIRN-7) Ot {Het sensan se Su f0h aaa Nouawos30 ‘GL7°09 (Nyriva)LaT HOS SIRUSNONI AAVSH T4SIENSLIA, quip Ww peunvaeytes s|q AMM KpONF FusnD oy win aw ANI ON NIDIUO JO SLVOISILYIO NasONCO AYH1 LOH OL 100-5 a OV.s38 aan alo sige et es gem eenes cas eeartoen \yrrso 0ce0: | Wikiw CIACOTIATC HvTIWA_ 17H, § AOHISNVL ON “G17°09 (NVTIVG)LTIOS S3IILSNONI AAWSH THSTANS.LIW3355553 eo? enor SIRN 7 Out 20 So ta Nao Nouanos30 ‘SaRuLSNoMI AAYH IHSINSLIW "vag ary spood Hun yay yer Ansa Aq NUBONCO AWA 1 ACH OL‘S.7e0 ayTvO:L THEO SSRASNOM MASH STENSLIA vzeee-s¥5, ceeeo80 unezas uibce-srs Meee 2 9 teooee-srs mute-38 23 beinee srs 25m 08.59 tsiaee Ss Grune 2 feiss are fate Suisse fume 3 ‘oote-sts ate-o8. 29 rene aes fever sre aon. tance fre ‘oe tao water srs oso cima: Stage srs soni OO teeece sos feiae 30-2 5100-08 30" ae "eel hge Tao Se onsen aa x S nottawos30 smuusnon anyon nisansin zag anny spoom Bawa yo} ein AED Aq DN {REZONCO AW I ROHN OL sreezastiseeve sera nant 1 Ya8Y INMeOTINIC NYTI¥O 1778.5 NOTIBNVL 86.0% HOS S3RLSNONI AAV3H IHSIBNS.LININSPECTION REPORT @ Interm s AT 0 IL No.SO.04/RI442/23 O Final CERTIFICATE OF MIGAS SATQOIL Doc. No. SAT-P-OPR-005-F9.MAKEMENTERIAN ENERG! DAN SUMBER DAYA MINERAL REPUBLIK INDONESIA DIREKTORAT JENDERAL MINYAK DAN GAS BUMI GEDUNG IBNU SUTOWO, JALAN H.R. RASUNA SAID KAV B - 5. JAKARTA 12910 KOTAK POS : 12961JKT 100.12 _TELEPON: 21) 5268010 (MUNTING) _FAKSIMMLE : (021) 5269114 e-mail: BERITA ACARA INSPEKSI dan PEMERIKSAAN KESELAMATAN Nomor : 107 / 56-225 / PA / DMT / 2020 Pada hari ini Senin, 10 Februari 2020 di Jakarta teish diaksanakan inspeksi dan pemeriksaan keselamatan pesawat angket antara PT. Superkrane Mitra Utama Tbk., Perusahaan Inspeksi PT. Indo Yasa Prima, dan Inspektur Migas dengan hasil sebagai berikut 1 DATAUMUM Pemilik 2 PT. Superkrane Mitra Utama Tbk. Item No 2 FLD25-2 Serial No 2 CFI8C- 82775 Model 2 FDQ5ND Tipe Unt Forklift ‘Kapasiias 2 20Kg ‘Boban Kerja Aman (SWL) ‘2500 kg Pada Load Center 500 mm Maksimal Tinggi Angkat 24000 mm ._ Pabrik Pembuat 2 Mitsubishi Tahun Pembuatan 2019 Digunakan 2 m2 Pabrik Mesin Masubishi Nomor Mesin SAS 336168 Putaran Mesin 35:3 KW 2250 p.m Lokasi Digunakan 2 Area Papua I PEMERIKSAAN VISUAL MENGACU PADA ASME B56.6 UNTUK FORKLIFT Berdasarkan dari hasil pemerksaan tampak mata, Kondisi terhadap Forkift secara umum Kondisi balk dan dapat beroperasi Ill PEMERIKSAAN UJI TANPA RUSAK Pemeriksaen uj tanpa rusak dengan metode maonetk partie! pada 1. Fork tidak diketeruan kondis retak 2. Sambungan antara Fork dan Arm tak diketemukan kondisiretak 3. Sambungan pin boom tidak diketemukan kondisi retakeKEMENTERIAN ENERGI DAN SUMBER DAYA MINERAL REPUBLIK INDONESIA DIREKTORAT JENDERAL MINYAK DAN GAS BUMI GEDUNG IBNU SUTOWO, JALAN H.R. RASUNA SAID KAV B - 5. JAKARTA 12910 KOTAK POS : 1296/JKT 100.12_ TELEPON : (021) 5258910 (HUNTING) _FAKSIMILE : (021) 5269114 _ e-mail: IV, UJI FUNGS! PENGOPERASIAN 1. Penguin fungsi pengangkatan dan penurunan Fork tanpa beban dalam kondis balk. 2. Pengujian fungsi pengangkatan dan penurunan Fork dengan beban dalam kondisi baik. 3. Pengujian fungsi sistem pengereman dalam kondisi bak. 4, Pengujian pada saat berjalan datam kondisi bak 5. Penguiian fungs safety device system berfungsi dengan bak. 6. Pengujan fungsi penyalaan lampu dalam kondisi balk. V. UJI FUNGS! BEBAN Pengujan Fungsi Beban mengacu pada ASME B56 6. Beban tidak melebihi rate load. Dan mengacu pada tabel beben ‘dari pabrik pemibuat. Tigi rlean rm] Becton | 20d Cener [meen ig = es +S ee V. KESIMPULAN ‘Berdasarkan dari hasil pemeriksaan dan pengujian diates, kami menyimpulkan bahwa Forkift masih dalam kondisi dapat diterima, aman untuk dioperasikan dengan beban kerja aman sesuai tabel pengujian diatas untuk dioperasikan dan digunakan pada kegiatan usaha minyak dan gas bumi sesuai dengan masa berlaku sebagaimana tertera dalam Sertifikat Inspeksi. Jakarta, 10 Februari 2020 Diperksa dan dsertifikasi oleh, PT. Indo Yasa Prima Oe, 2TYP certiricaTion a TECHNICAL SERVICES CERTIFICATION & TECHNICAL SERVICES: 100-014/LA-TYST/SUW205KT + aaa Tilt Range - Beban Kerja Aman (ke) Ti | Par | Times a Backward gaara Beban Uji (kg) | Alat Angkat | Alat Angkat (Derajat) ‘Utama Banu es 1000 610 300 7000 2500 = 500) 6-10 500 2500) 2500 : Kesimpulan : Berdasarkan hasil pengujian di atas, kami menyimpulkan bahwa peralatan tersebut aman dan layak untuk digunakan pada kegiatan usaha minyak dan gas bumi. Diterbitkan : Jakarta Pada Tanggal : 12 Februari 2020 Berlaku Sampai Dengan: 12 Februari 2024 PT. Indo Yasa Prima Inspector Direktur Stefanus Edo Ediyanto ‘Address : Ruko Buana Gardenia A23 — A25, JI. KH. Hasyim Ashari, Pinang -Tangerang 15145, Banten, Indonesia Phone : +62 21 7309609, Fax. : 462 21 7309610, E-mail: indoyosaprima@ymail.com : odmin@indoyasaprima.comINSPECTION REPORT Zi Interm s A T 0 | L No.SO.04/R/442/1/23 O Final MANUAL BOOK SATOIL Doc. No. SAT-P-OPR-005-F9.MAMITSUBI FORKLIFT TRUCE BISN crzsc-sso01.s0009 © FGEISN crstcoonsome BASEN crss2001.s0000 = FGEABN crusnorss CF2sc-75001-79999 FGEZOGN cre 30001-30000 BABZN cr4:72001-70000 © FGEZON crt70.2001.25050 G20CN crs<22001.20009 © FGE20ZN crs-200.200 CF17D-10001-19090 FGE25N cr170-70001.-79948 CF35-10001-19999 FGE25ZN cr35.70001.70000 CF170-80001-68999 FGE3ON cr12F-:0001-10999 FGE35N crisr-so001-20009) Nes tata: Resse, 0 tary Rice pegSATOIL INSPECTION REPORT @ Interm No.SO.04/R/442/1/23 O Final MAINTENANCE RECORD Doc. No. SAT-P-OPR-005-F9.MA SATOILPT. SUPERKRANE MITRA UTAMA Tbk HE) DI surcncrane HEA LIFTING CONTRACTOR AND EQUIPTMENT RENT Repaired By(mechane| Remar [aru a ri [ae [ears = | Wish titer, wines | Y ua ite Tis 1 [pa a Tinaterephg ios Tieyse rem fos [eu| seaman 7 antiraiter ousllng tat aster oping tas mss [PUASLLONCEM | Lye] sucman Heatal | ois i oon cr ae 1 oe a | ope eee TOERO| rake | Foard oo T Taner soyzozz | — raat —| Poo Borgia banark aPereN apd | Ban capa nan TOT [ae Baden erm 2 —Enge9 ‘Wiehe ‘iter “inca | ul rier ass [sas |_| sons | var | Poo Seay Gree Tinea 3-1 593] co | infos | needa] Poacs [Booger ban unan Pernt poor? [Ban Fang kona TAO wos ra invaSATQIL| . INSPECTION REPORT No.SO.04/R/442/1723 @ Interm O Final EMISSION GAS TEST Doc. No. SAT-P-OPR-005-F9.MA SATOILCertificate No: 2023-03-AN-3993-N Date: 2023-03-03 Page 1 of 2 Report of Analysis CUIENT : PT. Superkrane Mitra Utama Tbk. : Jl. Cakung Cilincing Raya No.9, RT.11/RW.4, ADDRESS ‘Semper Bar., Kec. Cilincing, Kota Jkt Utara, Daerah Khusus Ibukota Jakarta 14130 SAMPLE TYPE el SAMPLE DESCRIPTION emisi sumber bergerak ‘SAMPLE IDENTIFICATION 43-21-UE-384-N ‘SAMPLING DATE 2023-03-02 SAMPLING LOCATION ‘orklift 2,5 Ton (CF18C-82775 ) COORDINATE :0°0'0"S 0°0'0"E DELIVERY DATE RECEIVED DATE : 2023-03-03 SUBMITTED BY : Technician ANALYSIS DATE : 2023-03-03 - 2023-03-02 YOUR REFERENCE : 968-QUO-AI-03-2023-N-REV01 Authorized By, Eva Hasanah Direktur Teknis ‘This Report of Analysis val ont or am. sample and issued by the Company complies with General Condon print overt! or avaliable on request. Te acres or ty val Mons ara.cocer. Theatachnrs) aves anna part is Rap ot Ary. Wet tho Company, his Report of Analysis nol permite to bo duplicated o extract by any means wahout writen permission fom thoCertificate No: 2023-03-AN-3993-N Date: 2023-03-03 Page 2 of 2 Report of Analysis Tat REST FEST ESRTORY Una WETOOS SPECTRORTION 1 Opecty 50) % 12 0 ‘Suiee7r1822005 Notes:*) Accredited Parameters of KAN LP-720-IDN. PERMENLH NO 05 TAHUN 2006 LAMPIRAN | KATEGORI M,N,O diesel, GVW = 3.5 ton = 2010 Authorized By, Eva HasanahINSPECTION REPORT @ Interm SAT 0 IL No.SO.04/R/442/11/23 0 Final CERTIFICATE SPARK ARRESTOR SATO IL Doc. No. SAT-P-OPR-005-F9.MA41 Donaldson. To Whom It May Concem 31 Aug 2007 Re: Spark Arrestor Qualification Dear Customer, This letter certifies that the below mentioned Spark Arrestors have been qualified by the United States Department of Agriculture (Forestry) Equipment Development Centre, San Dimas, California 91773, submitted by Donaldson Company Inc... MODEL POSITION FCM04-5123-1 HORIZONTAL & VERTICAL FCMO08-0024-1 HORIZONTAL & VERTICAL FCM10-0016-1 HORIZONTAL & VERTICAL FCMO06-0037-1 HORIZONTAL FCM06-0038-1 HORIZONTAL & VERTICAL FCM06-5030-1 HORIZONTAL FCMO7-0068-1 HORIZONTAL & VERTICAL FCMO07-0069-1 HORIZONTAL FCMO09-0091-1 HORIZONTAL & VERTICAL The spark arrestors have been tested in accordance with the “US Forest Service Standard 5100-1 for Spark Arrestors” and have been qualified for horizontal or vertical applications. We trust this letter is sufficient and look forward to working with you. Yours Truly, =a Leo D'cruz* ‘Technical Manager Donaldson Filtration (Asia Pacific) Pte Ltd@ Ponaldson ‘To Whom itMoy Concern 91 Aug 2007 Re: Spark Arestor Qualification Dear Customer, “Thi ater cenies hat he below mentonas Spark Arasiors have been ‘uolfedby he Unted Sites Department of Agiclture (Feast) Equipment evelopment Core, San Dimas, Calfomia 91773, submited by Donaldson Company nc. MODEL, Position FoMoas123-1 HORIZONTAL & VERTICAL Fewos-0024-1 HORIZONTAL & VERTICAL HORZONTAL 8. Fewo7-0068-1 -FOWO7-0060-1 Fowos-009t-1 ‘The spark arestrs have been tasted in accordance wih the "US ‘Service Standard 5100-1 fr Spark Arreslors and have been quelfied fr hherlzontal oe vere appizaions. ‘We ist tis laters suffer and took forward to working with you. Yours Truy. Se Leo Dene Technica! Menager Donaldson Filtration (Asia Paci) Pe LisSATOIL FORKLIFT INSPECTION CHECKUST [te Of apace March 3 =< ena an Aaron a apa OORT a pr. Suertrane Mitre Vas wodahop FSi ————a [asics a —— = BCRT?S jrarsomnes : 2018 ho. " lees 2 P.Supetnne i vane hyve ting Apa vers atte, + Say ah Ccing Wo 98 TOS/04. Kel Serr Saat pt Fos ‘be Cincng nat tar 000 nos Jcxmcty 223 Ton pata ASME BS, 8 50.5057 [aoa [ana Montacare saa amber SATOIL smacomonnewT» an Lifting Equipment Engineers Association S ‘This is to certify that KD Armand Zachary Sukanday) passed, icate Part 4 Entra of the << ‘examination on Galdctober 2016 owy» on Lifting Equipment Engineers Association LEEA Academy Advanced Programing ‘This is to certify that XS ve Offshore Cont inced Programme ‘September 2017 — Mile (ue ner Gul | Programme Candidate Number: WTP3573, Date of Birth: 24 August 1989Ay SAR NDT SERVICES (SNS) Partner (OUTSIDE TRAINING SERVICES) CERTIFICATE OF QUALIFICATION Certificate No. SNS/MT/IN-22164 This is to certify that: ARMAND ZACHARY SUKANDAR PT. SATOIL Has satisfactorily completed 24 hours training and examined ‘in according With The American Society for Nondestractig Ne ing, Inc., Recommended Practice No.: SNT-TC- Edition and he is qualified for if: MAGNETIC PARTICLE regiing LEVEL II (Two) Passing Grade (%) General Specific (A+B+0)/3= |- Individual>70 Practi 85 80,7 - Composite >80 : | } | \ Reference Code/S' : ASME, AWS and Other National Codes/Standards Certificate Date: October 07,2022 Tangerang, October 07,2022 Expiration Date: October 06, 2027 eae tieaee(OUTSIDE TRAINING SERVICES) ee moat, ~~ SAR NDT SERVICES (SNS) Partner CERTIFICATE OF QUALIFICATION Certificate No. SNS/PT/IN-22158 This is to certify that: ARMAND ZACHARY SUKANDAR PT. SATOIL Has satisfactorily completed 24 hours training and media according With The American Society for srs Totne inc, Recommended Practice No.: SNT-T Edition and he is qualified for the of: LIQUID PENETRANT TESTING LEVEL II (Two) EXA! IN RESULT Type of Examination | Grade (36) | Composite Grade (%) | Passing Grade (%) General Hoe 9 Specific (A+B+(C)/3= | - Individual>70 Practi¢ 85 84,3 - Composite >80 I | Reference Code/Si : ASME, AWS and Other National Codes/Standards @ Certificate Date: October 07,2022 —_tangerang, October 07,2022 ( Expiration Date: October 06, 2027 ‘Examiner:KEMENTERIAN KETENAGAKERJAAN RI KEPUTUSAN MENTER! KETENAGAKERJAAN REPUBLIK INDONESIA NOMOR5/ 2¢2 /AS.02.01/ 1/2021 ‘TENTANG PENUNJUKAN AHLI KESELAMATAN DAN KESEHATAN KERJA BIDANG LISTRIK ENTER! KETENAGAKERJAAN REPUBLIK INDONESIA Menimbang : a. batwa untuk meningkatkan perindungan tenaga kerja den_membantu pelaksanaan pengawasen ketenagakerjaan, khususnya dalam pelaksanaan Norma K3 di tempat kerja, maka dipandang peru adanya tenaga Ani Keselamatan dan Kesehatan Kerja yang memilki Keablian khusus di bidangnya; . bahwa berdasarkan hasil penilaian syarat administrasi dan kemampuan teknis keselamatan dan kesehatan kerja terhadap ARMAND ZACHARY SUKANDAR, maka sesuai peraturan perundang-undangan peru. diberikan penunjukkan ‘sebagai tenaga Ahli Keselamatan dan Kesehatan Kerja Bidang Listrk; ‘bahwa untuk itu ditetapken dengan Keputusan Menteri ‘Undang-Undang No. 1 Tahun 197 Peraturan Menteri Tenaga Kerja R.1. Nomor Per. 4/MEN/1987; Peraturan Menteri Tenaga Kerja RI. Nomor Per. 02/MEN/1092; Peraturan Menteri Ketenagakerjaan R.l. Nomor 12 Thun 2015; Keputusan Dirjen Pembinaan Pengawasan Mengingat = Memperhatikan : 1. Surat Permohonan dari Pimpinan PT. 16 Januari 2021 Perihal Permohonan Perpanjangan tan dan Kesehatan Kerja Bidang Listrik 2. Laporan kegiatan Anii Kesel a tan Kerja yang bersangkutan. me y KEPUTUSAN MENTERI KETEN. ERJAAN TENTANG PENUNJUKAN AHLI KESELAMATAN DAN KESEHATAN KERJA KESATU —_: Memberikan Perpanjan \unjukan Ahli Keselamatan dan Kesehatan Kerja Bidang Listrik kepada; Nama > ‘ARMAND ZACHARY SUKANDAR: ‘Tempat, Tanagé +: Saint Louis, USA, 24 Agustus 1993, Perusahaan PT. SATOIL Aiamai + Taman Tekno, Serpong, Banten KEDUA + KapectNgploresin cee ORs KESATU ded Sagas maribants ceongswasl norma K3 di tempat kerja, membantu pimpinan perusahaan melakukan (Gentitkasi, pemerisaan, analisa dan meberikan persyaratan Keputusan ini berlaku selama 3 (tiga) tahun terhitung sejak tanggal ditetapkan ‘dengan ketentuan apabila di kemudian hari terdapat kekeliruan dalam keputusan ini akan diadakan perbaikan sebagaimana mestinya, Menetepkan KETIGA Ditetapkan di Jakarta Pada tanggal 29 Januari 2021 eae ain. MENTERI KETENAGAKERJAAN REPUBLIK INDONESIA DIREKTUR JENDERAL PEMBINAAN PENGAWASAN KETENAGAKERJAAN DAN KESELAMATAN DAN KESEHATAN KERJA yondang SNIP. 19840419 198903 2.001KEWAJIBAN DAN WEWENANG AHL! KESELAMATAN DAN KESEHATAN KERJA BIDANG LISTRIK Sesuai Peraturan Menteri Tenaga Kerja Nomor Per.02/Men/1992 jo Peraturan Menteri Ketenagakerjaan RJ. No. 12 Tahun 2015 Keputusan Dirjen Pembinaan Pengawasan Ketenagakerjaan dan Keselamatan dan Kesehatan Kerja (K3) No. Kep. 47/PPK&K3/VIN/2015, Kanoanyue Mec tempat sen dango ten peng b. Meminta keterangan dan atau informasi mengenai pelaksanaan syarat-syarat K3 bidang listrik pada tempat kerja sesuai dengan keputusan penunjukan ini, ‘¢. Memonitor, memeriksa, menguji, menganalisa, mengevaluasi, dan memberikan peryaraan era pembiear KS bing tk pace tempat hae nese! eongun hopin prion ow d. Menyatakan keberatan atau menghentikan pelaksanaar n yang tidak memenuhi Y Kewajiban : 6 @ Membantu mengawasi pelaksanaan erundangan Keselamatan dan Kesehatan Kerja di bidang listrik. b. Memberikan laporan kepada Ketenagakerjaan R.l. ¢.q. Dirjen Pembinaan Pengawasan Ketenagakerja tembusan Kepala Dinas Ketenagakerjaan ‘setempat dan Direktur in Noma Keselamatan dan Kesehatan Kerja mengenai hasil pelaksanaan 3 (tiga) bulan atau setiap saat setelah selesai melakukan kegiatannya de Penunjukan ri Ketenagakerjaan RI ©. Merahasiakan se¥jala Keterangan tentang rahasia perusahaanvinstensi yang didapat bermubungan dengan jabatannya. PERHATIAN: Apabila melalaikan kewajiban dan kewenangan sebagaimana tersebut diatas maka ‘Surat Keputusan ini dapat dicabut.01. 0003478 LSP MIGAS BNSP Licenced No: BNSP-LSP-0741D SERTIFIKAT KOMPETENSI (CERTIFICATE OF COMPETENCE No. 71203 3117 5 0001069 2020 NS een caer th Armand Zacha opndar No. Reg. IMG.07/ 2020 Telah bidang : Is cor in the area of : ie on ui reais o Testing and Analysis <>. Kualifikasi/Kompetensi : with Qualifcation/Competency : INSPEKTUR PESAWAT ANGKAT CRANE INSPECTOR Sertificat ini bertaku untuk : 3 (Tiga) Tahun This certificate is valid for : 3 (Three) Years Jakarta, 04 Juli 2020 LEMBAGA SERTIFIKASI PROFESI MINYAK DAN GAS (LSP MIGAS) Professional Certification Body of Oil and Gas SF Se Dr-InM.Yudi M, Sholihin, MBA.M.Sc Ketua LSP MIGAS ( President) eeeDaftar Unit Kompeten: List of Unit (s) of Competency ade Ua ma Tudul Unit Kompetensi Gate of Competency Unit Tale of Competency Unit ‘Heakitan Veftan Dommen Pesonat Anghat 1 [__m212n3s.001.01 | peronn vermcation of Gane Document ‘elokukan Ideas Pesawat Angkat .712035.002.01 | To pera laecaton of Gane Menerapkan Keseiamatan Kera oi Temp Ca 1M-712035.003.01 | To agoly OHS inthe Work Pie elakukan Pererksaan dan Vertis Siar operon ispecon and Veraben of Stature Telakukan Pemerksaen dan Verfias Kat Pemegarg Beban M712035.005.01 | operon Inspection and Vetcatn of Hook 14.712035.004.01 To peratm inspection and verticaton of iting gear (M.712035.007.01 CL raf Bae: To perform Inspection and Veritcation of Rope Stee! 2 —- Te pera Inapecton and Vartenton of Rog Part ‘akutan Pemerisaon dan Veritas Sisen 2 3 a 5 6 | mn |e ene 7 8 ° To pero Ingen a Vartan Hey n7amscona | Reba meron Vettes Boer an Ba oy 1¥.712035.008.01 10 | m712035.010.01 11 | .712038.011.01 12) mrizosso1201 13 | mz7i2035.013.01 14 | 71203501401 15 | M.712035.015.01 16 | ™.712035.016.01 17 | 712035.017.01 48 | m.712035.018.01 TUK 027 Jakarta, 04 Juli 2020 Lembaga Sertifikasi Profesi Minyak dan Gas (LSP MIGAS) Professional Certification Body of Oil and Gas Dr. Azwar Manaf, M.Met Ketua Sertifikasi (Certification Chairperson)Sertifikat Certificate LEMBAGA PELATIHAN KERJA KOPERASI PRIMA DAYA.MIGAS (LPK KPDM) ° \ menyatakan babwa() certify that: ARMAND ZAC! / SUKANDAR PT SATOIL OILFIELD SERVICE telah sebagai: 1as QUALIFIED as: INSPEK’ LAT BANTU ANGKAT g jing Equipment Inspector for having com iting Equipment Inspector Qualification Course conducted on?" - 12" of December 2020. 8 LEVEL 1 pada Bimbingan Teknis rama fat Bantu Angkat yang diselenggarakan tanggal 7 sampai dengan 12 Desember 2020. i >) Ketua LPK KPDM Nomor Sertifkat 080/LPK/KPDM/1ABA/2021 Chairman of LPK KPDM Certificate Number 3 ‘Beclaku sejak 27 Januari 202% Certificate effective date Berlaku s/d 27 Januari 202 Volid une Ir, Bayu Wahyudiono, MM. eit ae era tp aon me PPO sean eae cc pos nh NAPA eaNomor Sertifikat Certificate Number MATERI BIMBINGAN TEKNIS KUALIFIKASI INSPEKTUR ALAT BANTU ANGKAT LIFTING EQUIPMENT INSPECTOR QUALIFICATION COURSE SYLLABUS +:080/LPK/KPDM/IABA/2021 Hasil : Baile (Good) Result INTRODUCTION OF ESDM LIFTING EQUIPMENT INSPECTION SDM SAFETY REGULATION ‘ASME 830.1 ASME B: ASME 830.9 ‘ASME 830.10 ASME B30.16 ASME 830.20 ASME 830.21 ASME 230.26 BRITISH STANDARDS ~ BS EN 13155, BS EN 13157, BS EN 1341: BRITISH STANDARDS - BS EN 13889, BS 1494, BS, BRITISH STANDARDS - BS 4429, 8 en 102415 Kriteria Nill Hast! Kuallfikasi Score Range of Qualification Result BRITISH STANDARDS ~ BS EN 12079, BS EN 12305, BS EN. an ak Sekeali (Excellent) Balk (Good) Cukup (Fair) >90s/d 100 >805/d90 2708/4 80 ‘Ambang Kelulusan (Passing Grado) = 70 180 3076 150 326 150 4309 Mv 2.7-4 (NDT KNOWLEDGE (METRIC PRACTICE JACKS, IN SUNGS Hoo) \b CHAIN HOIST (CHAIN BLOCK) in HOISTS ‘THE HOOK LIFTING DEVICES (LIFTING BEAM/SPREADER BEAM) RIGGING HARDWARE ‘CARGO CARRYNG UNITS (cCU) LIFTING EQUIPMENT APPLICATION LIFTING EQUIPMENT LOAD TEST xD ILLERS, AIR CASTERS, AND HYDRULIC GANTRIES KOORDINATOR INSTRUKTUR Instructor Coordinator TRI PURWANTOLEMBAGA PELATIHAN KERJA KOPERASI PRIMA DAYA MIGAS (LPK KPDM) SERTIFIKAT Certificate INSPEKTUR PESAWAT ANGKAT ESDM (Energi Bi Sumber Daya Mineral) ESOM Crane Inspector Level 1650 Diberikan Give ARMAND RY SUKANDAR ATOIL Sebagal Peserta Bimbingan Teknis Kualifikasi vane if Pesawat Angkat (Refreshing) yang diselenggarakan oleh LPK Koperasi Prima Daya Miges di Jakarta pada tanggal 23 s.d 26 Juni 202 predikat LULUS dan hasil BAIK. as participant of Online Crane Inspector Technic AGHEINOAA ‘wanon aM NOUSSESNI WWD IWSISAHS INGISAS WOR DTA ANY BNYuO OUVANNa GNY ONAVEGAH BNVEO SIEOWN NOUVINOY ALBaVS “BURLOMALS GNVEIvaSe BNVES ‘BNO WO S01LOvad 33VS ROMLDBSSNI 08 aNVHO 1881, avo) NYE, NOWOSASNI SOU ONIANS {1831 SALOMUISEO ONY GOUd TWRIBLVH NOUSSISNI LON souDvea ORL AQ \30 ALS sya NOUVOIsLLMBO GNV NOULO3ESNI BNVO NOUONGOMINT SMOTION SV SaINVINNS BUY ONINIWEL SLOArans SMOTIO4 SY SanuvMMNE Ju¥ ONINIVaL SLograNs