MATERIAL DISPATCH REQUEST

For CII Material Control Use

Requested by Subcontractor : PT. ADHI KARYA MDR no.: MDR-AK-STR-0130
Requestor : Sarpan Date : 27-Jan-2023
Date Requested : 27 Januari 2023 (*) XX : Category Code

Category Steel Structure (Q4)

Purpose Permanent Installation Temporary Work

Testing Others

Material to be used at Area: 4833-ESS-0001

(by Engr.) (by Engr.)

Request
No. CWP Description of Material Dimension Remarks Shipment / Package
Qty
1 4833-ESS-0001 BOLT M24x110 250 Laydown SS Chiyoda

Checked by Authorized CII Engineer / Supervisor

Name / Signature Date (27-01-2023)

Note :

Issued by CII Material Control Section Received by Subcontractor Requestor

Name / Signature Name / Signature

Sarpan
Date (27 Januari 2023) Date (27 Januari 2023)