BERITA ACARA SERAH TERIMA

No: 0001/BAST-PART-CONS/IV/2023

Pada hari Senin, 31 Juli 2023 telah dilakukan serah terima Pihak Pertama kepada Pihak Kedua
Pihak Pertama : PT. Gajah Utama Internasional
Consaigment Parts PT. THIESS site KCM
Buhut Kalimantan Tengah

Pihak Kedua : PT. Tempirai Inti Energi

Dusun manarang, Desa lungkuh layang, Kec. Timpah, Kab. Kapuas
Prov , Kalimantan Tengah

No. Name Part Number Qty

1 10788259 Front U-BoltBolt 8
2 13025424 Front Panel Body Assemblyel Body Assembly 1
View Mirror, Front Floor L(Right Rudder)(Right
3 13101017 Rudder) 1
4 13546545 Degassing Tube Bracket 1 3
5 13627177 Assy,Protective Plate,Right Pedal 1
6 13721785 Panel 1
7 13721915 Panel 1
8 21005265 Bolt-M18×1.5×120×1.5×120 8
9 60025666 Limit Block 4
10 60075176 Double H Valve Gasket 1
11 60104185 Push One Joint 1
12 60104191 Push One Joint 1
13 60104192 Push One Joint 1
14 60110160 Front Brake Chamber Assembly(Right) 4
15 60115755 Push One Joint 1
16 60117670 Door Lock 1
17 60117671 Door Lock 1
18 60118234 Wiper Brush Assembly 2
19 60118854 Right Door. Glass Lifter. Assy 1
20 60118857 Left Door. Glass Lifter. Assy 2
21 60125276 Oil Seal 3
22 60144883 Nut M12gb6177.1 Grade 10 4
23 60147352 Bush 4
24 60147379 Taper Thread Grease Nipple 4
25 60147413 Axle Packing Ring 1
26 60148621 Right Clearance Lamp 1
27 60148626 Left Clearance Lamp 1
28 60175479 Push One Joint 1
29 60190934 radio 1
30 60194020 Tube Sleeve 3
31 60212957 Limit Block 4
32 60213186 Plunger Pump 1
33 60222880 DISCHARGING VALVE 2
34 60223448 Ball Joint 30
35 60223450 Elastic Gasket 35
36 60223464 Ball Joint 10
37 60223465 Snap ring 10
38 60223466 Elastic Gasket 10
39 60231716 push one joint 1
40 60238421 Hand brake valve assembly 1
41 60238422 CLUTCH MASTER PUMP RESERVOIR KITTLE 1
42 60256118 Range cylinder 1
43 60256120 single H valve 3
44 60287318 Back cover gasket 1
45 60314563 O style packing ring 4
46 60327523 Oil Filter Element 200
47 60328251 Relay 8
48 60335083 Bushing 8
49 60335084 gap adjusting arm 2
50 60335115 Return spring 12
51 60335120 Bush 4
52 60335123 Bush 4
53 60335126 Upon brake friction plate 24
54 60335181 Automatic ga adjusting (left) 1
55 60335182 Automatic ga adjusting(right) 1
56 60343646 Air route control valve 3
57 60343677 Cylinder block liner 1
58 60343682 framework oil seal 3
59 60347433 push one joint 1
60 60351739 bearing cap 1
61 61000099 Starter Motor 3
62 61006370 Shock Absorber 2
63 61006543 Turnover cylinder assembly 1
64 61008691 Bearing 8
65 61009657 Cage assembly bearing 1
66 61011873 Wiping Interval Regulator 1
67 61013525 Headlight / Haed Lamp 1
68 61019283 Clutch booster 1
69 61020011 Pressure switch 1
70 61022207 flexible shaft 1
71 61022208 flexible shaft 1
72 61025204 press switch 3
73 61025757 Row-Steep Roller Bearing 2
74 61028574 Screw 15
75 *141502000017* Fresh Air Filter (AC) 10
76 120101060041A Screw 12
77 130201000040A095 press switch 3
78 130201000040A125 cylindrical roller bearing 2
79 130201000051A044 synchronizer assy 1
80 130288000159A press switch 3
81 130288000660A oil seal 3
82 130288000662A Deputy box fork 1
83 130288000707A synchronizer assy 1
84 130288000722A One-week bearing cover gasket 1
85 130288000731A synchronizer assy 1
86 130288000734A One-week bearing cover oil seal 3
87 130907000306A Oil Suction Pipe of Lifting Cylinder 1
88 130907000307A Oil Pressing Pipe of Lifting Cylinder 1
89 130907000915A Throttle control guy 1
90 130999000058A rear suspension 1
91 130999000122A Splashboard, Front Left 1
92 130999000123A Splashboard, Front Right 1
93 131401020117A011 Row-steep roller bearing 2
94 131401020117A013 Wheel bolt 40
95 131401020119A002 Friction plate 8
96 131401020134B053 Disc, Friction, Lower 28
97 131401020433B003 Axle Shaft (Right) 1
98 131401020433B004 Axle Shaft (Left) 1
99 131401020433B046 Axle Shaft (Right) 1
100 131401020433B047 Axle Shaft (Left) 1
101 131401020595A009 Grease packing 2
102 131401020776A002 Brake drum 1
103 131402010039A001 Row-steep roller bearing 4
104 131402010221A003 Brake Drum 1
105 131402020002B008 Nut, Flange 40
106 131501000005A006 Balance Suspension Seal 2
107 139999000895A Lower track bar I 1
108 139999000896A Lower track bar II 1
109 141501000202A001 Compressor DSK-HD 3
110 141601010101A Headlight 1
111 141601010102A Headlight 1
112 141601020057A Side Lamp / Taillight 1
113 141601020058A Side Lamp / Taillight 2
114 142099000045A Delay relay 1
115 142501000492A Rocker Switch 1
116 142999000182A Box, Junction 1
117 146399000018A Voice alarm 1
118 151099000093A single bend hose assembly 1
119 151099000105A Hydraulic-lock tube 2
120 151099000134A single bend hose assembly 1
121 151099000135A single bend hose assembly 1
122 151207000014A pressure joint 1
123 152503990036A001 Fitting, Quick Coupler 5
124 152599000200A Hose Assembly, High Temperature 1
125 160101100046A016 Turbo Charger 2
126 160101120038A001 Fuel Filter 35
127 160101120038A019 Injector 24
128 160602010079A Desert air filter assembly 1
129 160602020036A Air Filter Primary Filter Element 49
130 160602030026A Air filter elementnt 49
131 160801050034A Intercooler 1
132 A210110000012 Screw / Bolt M12x70GB5782 Grade 10.9 20
133 A210110000384 Bolt M12×110GB5782 Grade 10.9 2
134 A210111000270 Bolt 12
135 A210114000120 Bolt 24
136 A210306000013 Nut 3
137 A210319000021 Nut 24
138 A210401000006 Washer 5
139 A210491000144 Gasket 8
140 A210804000001 Oil Nozzle 4
141 A222000000030 Shock Obsorber 4
142 A222100000393 Filter Power Steering 50
143 A229900002965 Throat Collar 2
144 A229900002973 Washer 4
145 A229900003129 BRAKE HOSE Q-22-800WA 1
146 A229900003130 BRAKE HOSE Q-22-700WA 2
147 A229900004636 PIPE CLAMP SHEET 2
148 A229900004637 PIPE CLAMP BUSH 2
149 A240500000091 ELECTRIC TWO-TONE AIR HORN 1
150 A240500000097 Electric horn assembly 1
151 B230103001188 Rubber Hose 1
152 QDP004916675 Air Reservoir 1
153 QDP004930819 Rear Suspension Cushion 2
154 QDP004931388 Front Suspension Cushion 2
155 QDP005086948 steel tube of air compressor 1
156 QDP005093434 Guide Plate 4
157 QDP005093742 Rear U-bolt 8
158 QDP006304845 steering tube 1
159 131402010049B001 Oil seal 4
160 61005716 Clutch Release Bearing 2
161 130699000049A Clutch Driven Plate Assembly 4
162 130699000050A Clutch Pressure Plate Assembly 1
163 60288840 Gear Pump Assembly 2
164 130288000732A synchronizer assy 1
165 130201000051A007 Clutch Housing Gasket 1
166 139999001174A Manipulator 1
167 60110159 Front Brake Chamber Assembly ( Left ) 3
168 131699000040A Rear Leaf Spring 2
169 60223449 Snap Ring 26
170 152503990071A Relay Valve 2
171 130999000098A Splashboard, Front Right 1
172 130999000097A Splashboard, Front Left 1
173 60118250 Switch , Combined 1
Hand Adjusted Right Outside Rearview Mirror
174 13100993 Assembly (RHD) 1
Hand Adjusted Left Outside Rearview Mirror
175 13100882 Assembly (RHD) 1
176 160801040062A Radiator 1
177 160603020024A Fuel Water Filter 1000053558 42
178 160101120038A002 V-Belt 612630061046 ( 6PK-1275 ) 1
179 160101120038A003 V-Belt 6122630061125 ( 10PK-1280 ) 4
 Catatan : Spare part diterima dalam keadaan baru dan baik
Consignment

Penyerahan barang telah dilaksanakan oleh kedua belah pihak diserah terimakan oleh PT. Gajah
Utama Internasional Banjarmasin dan diterima baik oleh PT. Tempirai Inti Energi Indonesia dalam
keadaan baik, lengkap, dan seluruh perlengkapannya siap untuk dipakai sesuai dengan pemeriksaan
(checking) oleh kedua belah pihak.

PIHAK PERTAMA PIHAK KEDUA

PT. Gajah Utama Internasional PT. Tempirai Inti Energi

Akhmad Aziz Afrizal

Parts processing