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    Trench _ Lowering Report Pemasangan Jalur Pipa Gas Kawasan PT. KHS

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    10 views48 pages

    Trench - Lowering Report Pemasangan Jalur Pipa Gas Kawasan PT. KHS

    Uploaded by

    filmhanya123

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    PT.DUTAUTAMATEWIKABAD! | TRENCH INSPECTION AND | ewe cTtocrasrnn Fos cea ene meres exreyarrmorzaTion | Eyam FORM ca ‘TRENGH INSPECTION AND ENTRY AUTORIZATION FORM cation SiRUAs pate: 7 oe Weather Conition Bap Icrew Leader 22870 [rupersisar® 7 Dimentons [Deni ves _ No Hazardous Condition Top ao ‘A Slacking powom wie. 2 [i vo lO @ soon Below Water Table ae Soil Type: Tested oo _... Bulging Walls) GASolid Rock, Shale O Yes o Ga Floor Heaving Average Soil No o 8 Frozen Soil Citi Materia oo Super = Imposed Load Loose Sand oa Viorator Goo Wet Soil Protestion Methods Placcment of Spot & Equipment (Wall MUST he Vertical -No Vota) Oo @ x Spoils at Least fet foom edge of tench ‘Shoring oo ~» Spoils not increasing super - imposed load DTimber OD... Backhoe at end of trene Pneumatic (liydrautic a Screw Jacks o Oo Located in protected area [Trench Shield oo Within 25 feet of sae travel Eneven, Irregular Walls Goa ‘Secured! Tatrench Box ote Extend 46 inches above the landing [Sloping Bris) D214) fm ._ Lead to safe landing: [ves No. Environmental Conditions 1 ‘Other OG Gas Detector used? 1) GE Shoring Eauin, &: Mats Inspected prior to use? C)___B Confined Space Permit Issued?” GD _Istrench Safe: to Hater? [comment magrcckon Pedalaonan 1A dm 1600 (Ruki Davi aks Sadlack ras Weber a Cad bale Geaparae Uo Work Order # a Note: All unsafe condifion must be coreted prior © trench entry. any hazandous condition are observed, |e wench nust he immeaaely evacunted and no one allowed to te-enter untileorective acion has been taken Prepar by 7 fe [checked by fae ee o* C Maes ts C92I0 ae aa esee (cas (Ai) Pr.oura urama TeHWk Asani LOWERING PIPESPOOL 7 _ Pipa Distribusi Gas Area Kawasan Indust PT. KHS ‘Report No: DUTAICUTIBIG.P23-002200 PT. BANTEN INT! GASINDO ‘Job No: P23-0022 PT. DUTAUTAMA TEHNIK ABADI Date : 00-Jan-20 frost | so ent nie a Dr-Bie—pite2-22~ | 7/2] Jay By JN BS W26242 |iedeye | Pevesr REQUEST. ul-o he InN Be. ANE, 126242 |1262. Ter lamplk KO /Pwa. | 1 Tee 88. IN_IY 262.42 |1Le2y, (20242 Se | 498. IND g 5 12624 [PT-B1G -PipL2— 22 W192 JY 93 -| 262 92 fi2dege HzO 2 Hy |ga.9y JIS 1262 y2| (26242) IY GE INI? 1262 12h 4.98. IN. 99 1ebe G2 | 2é2g2 [PT. DUTA UTAMA TEHNIK ABADI [Prepared by [Shocked by Susaeno Pea |r 41 oe fob [ord T27Be 7 LOZ 6/12/2023 - 09:54 Cutting Pipe Material Traceability Report (COMA) Page Loft = an Pr. BANTEX IT GABOO a CONSATANT ENGINEERRG rane mea awa be som = [7 mee ———— a | a = ree aD wa = Te aE Oe ane ao mea NO. ane A ¥ ay 3 =F 01-86 —FIPL2-25=I0 ALS “ ee ee spi Bre SPE MB = al pot S/o J weetnaraces | CEN! SY | PT. BANTEN INT! GABINDO te pee F Be a a | ee. CO Foarneun| © es me 21-BIG~PIPL2~ 25-18 ine ae 5 ae GisBN-PAL2-23-1-O) al ere E. r 2 4 [oe ) Pr 90a Tama remus! TRENCH INSPECTION AND | buexe stneourastryte ounce ama arin ENTRY AUTHORIZATION eco FoR ine "TRENCH INSPECTION AND ENTRY AUTORIZATION FORM roca Creuas, ower TF fens pots Time of Inspection SO Weather Condition: DAY aa Icrew Leader ears Supavisor: Wlernr Pe Dimentions = Depth 73 #7 |¥es_ No Havardous Condition [for [Wee |: oo [OG ...... AirSlacking ou Borom |W: oj ju: zo [OO ms Below Waer Table Soap Te Oo ‘ueing Walls) DiSotid Rock, Shale Yes oe Floor Heaving = DaAverage Sot | No oo Frozen Soil Fin Material ag Super «Imposed Load Loose Sand oo Vibrator Ia oO sa. Wet Soil Protection Methods Placement of Spoils & Fauipment (Wall MUST be Vertical - No Voids oe Spoils at Least 2 fet froom edge of reach Shoring ag Spoils not inereasing super = imposed load Cimber @a 1. Backhoe at end of trench CPreumatic sor teat remot location Biiydrautie Ladue Location screw i - ao Vacated in protected area Ditecnch 5 @o ‘Within 25 fet of sate travel Teregalar Walls ir Secured Ditrench Box ao@W Extend 36 inches above the landing Sloping as) Dien [a oO _. Lead to safe nding ial [ves No] ‘Environmental Conditions + ‘Other ClO GasDetector used? GG _Shoring Equip, & Mas tnspected prior use? CC Confined Space Permit issued? BO _ ts trench Safe to Emer? [Comment F Work Order = Note: All unsafe condition must be corected prior 10 (rench entry. If any hazards condition are cbserved, the teach nust be immediately evacusted and no one lallowed vo re-enter untilcorective acion has been takes Prepare by F [Checked [Approved by ( ae Name 44 cwm—re "Wane LWwARMo Name a oS iss css @ C fw cis be A Prouraurama TeHWik aaa LOWERING PIPE SPOOL Pipa Distibusl Gas Area Rawasan Mush PT RS Repo No DUFACUTBNG FDORIOG PT. BANTEN INT GASINDO PT. DUTA UTAMA TEHNIK ABADI i eo ae | pr-Big-Pype- 23-u~| Zo | Tey e | P ob2| Poa |izerqe| izbeye |e, | 08 Jo | gm 180 o' leon levee |izszg2] beq2W M1 g" PREASING 8" our Le | yee aa [Pr DOTA UTANA TERK Aaa FT BANTEN iT GASHOO Prepared by Gheckoa oy [Annoved by Frnt eB Sunn 1 oo 2 ee Y se r [bate T (= 06 = %677 17-06 = ROZS TEM oe 16/06/2023 - 15:14 Cutting Pipe Material Traceabity Repor {CPMTR) Page tof (Fiemme \ Peedi Fieenea] [ieee por com ReBle-Spost. 4, |] Jxeaemmemeamo0 ‘CORSIATANT ENGHEERING oa aw. oe Reames 7 me DT-BIO-PPLZ~23 Paw ou 0, Pre ons va, Sy SF ok EP Re Gr oepe ees SLA a eee 7. OUTA UTAMA TEHNIK ABADI TRENCH INSPECTION AND Deets sPMOUTA STV mca mom oH ENTRY AUTHORIZATION Dae napa pcm Ea) TRENCH INSPECTION AND ENTRY AUTORIZATION FORM [Location RGAE pac: “FOG - 202k [rime oF Inspection : i Weather Condition DRE cael ~ Icrew Leader P70 Supervisor [Dimentions« Dems 0 8 ves No Top wag fe 2° (0 & [Bowom |W.s z\o @ Below Water Table Soil Type: Tested og Bulging Walls) Cisofid Rock, Shale G ve: ag Floor Heaving average Sot |B xe Oo @ Frozen Soil CFM Mateish of Super - Imposed Load Loose Sand ao Vibrator i a Wet So Protection Methods = Placement of Spoils & Equipment (Wall MUST be Vere - No Voi af Spoils at Least 2 fet froom edge af wrench Shoring ag Spoils no increasing super - impose load ‘|q oa _ Backoe atend of tench Gvdrauie Giscrew Jacks a Tocated in protected area Bitreneh Shield a Within 25 feet of sae travel never, Irregular Walls eo Secured Citreneh Box ao Extend 36 inches above the lan loping. 4s) O24) ness Lead to saft landing yes _No Environmental Conditions = Other GD Gas Detsctor wed? ToC Shoring Equip, & Male Inspected prior to use? B__O Confined Space Permit issued? C1 strench Safe to Enter? [comment E Note All unsafe condition mos be corected prior to rench entry. Ifany hazardous condition are observed, the trench must be immediately evacuated and noone | allowed to reenter untcorstveacion has been taken = Ba, - pani a , Nae Apt werserecee ——_Iname —; Pande EEF Iname — DRY crew Leader Dato Supervisor: POA [Dimenti Depth [ves No Hazardous Condition Top |W: r oo Ar Slacking Bottom _ |W: Lh: og Below Water Table ‘Soil Type: Teed |O Bulging Walks) i THSold Rock, Shate Ove oo Floor Heaving a Claverage Soil Ono o@ Frozen Soil Fin Material - TO rvnssn Super - Imposed Load Loose Sand of Vibretor MO ........ Wet Soil Protection Methods ‘Placement of Spoil & Equipment or ~~ Spoils at Least 2 feet froom edge of trench o ‘Spoils not increasing super - imposed load SaTimber 2a .=- Backhoe at ond of trench Pneumatic o Compress, ce. at rots location Ditydrmaie Ladder Location sees nck Zo Trocated in protested aca (French Shield go Within 2 ict of sae travel Eneven, Irregular Walls, wo. ‘Secured TiiTrench Box Det Sa ieee bevasbore Oe liating |Stoping Mia) Oiwiern |e a Lead to safe landing | ves Ne Environmental Conditions: Other TD Gas eestor we? TS Shoring Equip, & Mats Inspeetedprier 0 we? [11 Confined Space Perit issued? AYO tstrench Safe to Ener? [comment =a Work Order # Note: All unsafe condition must be corected prior © | cnch entry. I'any hazardous condition are observed, he trench must be immediately evacuated and no one allowed to recuteruntileorective acon has been taken Prepare by [checked by [Approved by = [Name Ae Name Starnes ___JName Manurwry cass Por [ctass OF ft cass fom prejee! PT-BiQ-PiPL2- 23~ $262 47 | izbi92 W- og 426192.) 2eiez, 126132 | 26192 126192} 26192 ote 6 i b 1264 126132] We Weipa. lebron Lizb2de (262.42 24 ia i262 G2lizee 424 Wn ee 491 126241 Pr-Big-Piple- 22 - RSI Pe ee pels [oe 1262 92, dit i262 [262 4, [PT. BANTEN INTI GASINDO [Approved by Rohmen ranvpurg Ge OE 15/06/2008 - 15:16 ‘Cumtng Pipe Material Traceability Report (CPMTR) page tof2 PT.DUTA UTAMA TEHNIK ABAD Date: 14/02 /20%S see Spoot mo ott ho LOWERING PIPE SPOOL Remarks DT- BIG FIL 2-23 ~ Wao Dr-bia- PIPL 2-23 - Mi = 4 [PT. BANTEN INTI GASINDO. [Approved by ria _ Inga arp 1 [EE 7 Ter 16/06/2028 - 25:16 ating Pipe Material TraceabityRepon (CPMTR) Page Loft (AR) PROUT uTaM TEHWK ABAD! PT. BANTEN INT! GASINOO Pipa Distribusl Gas Area Kawasan lndusil PT. KAS Contractor PT. DUTA UTAMA TEHNIK ABADI 1903202 Wo we Lie Wo Spon doit a fei Pe No Hat ante fears Pr Sia-Pirez-22~ | Ye | wiz9 é'col Peg | p22 iz6zelizeega Mase IN. 180 e-spl P22 IP. 180 |irez 42|raboey e IN Bi /nen|e'go| 2 Bo |P. 100 |\262 q2lirbey CToTAL. > prpe y 4186 4 [Py DUTA UTAWA TERNIK ABABT 157 BANTEN INTIGASINDO = Prepares by [ciecie By [roprovediny [Print Name AR SWwaRy o* hon franuaprg Da : |sionature ‘g 2 ate ATT 1G fea [202 Yel [ur 13/07/2023 - 09:03 Ccuting Pipe Material Traceability Report (CPM) Pope Lof FT. DUTA UTAMA TENN ADABE TRENCHINSPECTIONAND [eee rteTaseryn Foy — Sa L FORM e_ TRENCH INSPECTION AND ENTRY AUTORIZATION FORM [Location STe -Cituas [Date 1270) Jace. [Time of Inspection Weather Condon: ‘PRY [Crew Leader Daere [Supervisor: PALS WARTO [Dimentions: Dept Yes No. Hazardous Condition oa i o @ TA Siacking Bowom |W: | «(oa Below Water Table Sol Typet Two Bulging Walks) Sold Rock, Shale 1 Yes ae Floor Heaving Chaverage Soil No ven Frozen Soll OF Materia CO cnn Super Inponed Lond CiLoose Sand ag Vibrator ao. We Soil Protection Methods | cement of Spoils & Equipment (Wall MUST be Vortal -No Ford oO @ Spolls ot Laat fet Raceage ofeach Shoring o Spoils not increasing super - impose load Ditimber eons ercacs Backhoe at end of wench Pneumatic _- Compressor at remote location 2 fen ae Ladder Location Eisorew Jacks o Tecate in provected area onan wo Within 25 fet of sae travel ze Eneven, irregular Walls a= eee Drench Box nesses Entend 36 inches above the landing Stoning tia Oiaicy Io Lead to safe landing ives No Environmental Conditions: Other CO Gas Dacor used? TL (Shoring Equip, & Mats Inspected prior to use? 1 Ci Contined Space Permit Issued? AC Istrench Safe to Enter? [Comment Work Onter# Note «All unsafe condition must be coreced prior eench entry. 1° aay hazardous condition are observed, the trench must be immediatcly evacunted and no one [lowed to re-enter utlcorectve ation has been taken Prepare by csekea by [Approved by Ge Mor: heme: fat Ivame — ; LUMWIARND Name: PP Mlanurany ICiass, Ao cls Ww) fee [Class Bom Prejec JA. PTDUTAUTAMA TEHNIK ABAD] LOWERING PIPE SPOOL ® Pipa Distribusi Gas Area Kawasan indusii PT. KHS PT. BANTEN INTI GASINDO- PT_DUTA UTAMA TEHNIK ABADI [Form No FA®DUTA MECH 20 Rev 0 Report No > DUTACUTIBIG-P23-0022/00 Job No : P23-0022 Date ; OoTaADO 17/07/23 Contractor : " wa Line Wo Sect Jott Ho = Pipe No vot Number oe PT-Bia-PiPis-23-| 74 | In 18D le-42| Proo_| F 18 is 12 IN, 18 gol Pe | P0499 eee (30M Ye \IN. 184 ~Y6| P0979 |P- ING. IN. 185 le“g@l Fue |P_woc 4, y IN. 186 bMS Bros | Pou TN 182 Go| P. 12+ TEN FT_DUTA UTANA TEP ABADI [FT BANTEN NTT GASINDO Prepared by [Eveckoa by proves by ret Name ra é LU ARNO Rohwer rianarars ( eaganre ab phe Tar POR EOE TF [eT] aeb* 13/07/2023 - 09:01 Cutting Pipe Material Traceability Report (CFAETR) Page Loft. ENTRY AUTHORIZATION PT. DUTA UTAMA TEHNIK ABADI “TRENCH INSPECTION AND. bem cpeourasen ay Don tease FORM newt TTRENGHT INSPECTION AND ENTRY AUTORIZATION FORM [rocation Ye = CLLuA: [Date [Time of Inspection a Weather Condition pea z oS : ICrew Leader ALTO [Supervisor : NUS WAN TD [Dimentons Dent ves No Hazardous Condition Top |W: ao Air Slacking IRotiom [Ws ft oo Below Water Table i Son Type: Ted Jo oO Bulging Walls) TSotit Rock, Shale Gye oo oo ving DiAverage Soil Oyo aq a | CAF Material ml ‘i Loose Sand oo. Mo. s Protection Methods : Placement of Spoils & Equipment ‘Wall MUST be Vertical «No Fou ow Spoils t Lest 2 tet loom edge oF tench Shoring o 7 Spoils not increasing super - imposed lnad Ditimber TC sssnrns Backioe at end of trench 7 TPheumatic Ip o Compresor et. t remote Featon iivirwlie Ladder Location screw Jacks wo TTocsed in protected ar Trench shila @oa Enoven, regular Wall aac Citrench Box DO oevesnsns Extend 36 inches above the landing, z Stoning tisusy omeon [go taltathedne [ves No Environmental Conditions Other TO Gas Detector used? (1 WW” Shoring Equip. & Mails Inspected prior to use? Ci Confined Space Permit Issued? (_L_ ts trench Safe to Enter? [comment ‘ ui Work Order # Note: A onsafe condition mus be consced prior to lrench entry. Hfany hazardous condtion are observed, ne ucoch mst be immediately evacuated ard one [slowed to reenter unlleoretve acon as been aken |Prepare by [Checked hy JApproved by 7 ae “oaled Le Name: AB Name = SWARM Kame “> eatl Ictass AD Jelass WIL ec cians stolen Pralect A | PTDUTA UTAMA TEHWIK ABAD! Pipa Distribusi Gas Area Kawasan Industri PT. PT. BANTEN INT GASINDO PT. DUTA UTAMA TEHNIK ABADI DW Line No Spool No Joint No LOWERING PIPE SPOOL @> iad ‘Report No : DUTAICUTIBIG-P23-002200 ‘Job No : 23.0022 Cae aosense 19/29/22 Remarks DT. BiG -PIPl 2-23 -Ill~ %, N18 2 IN 18S tmee ge 26132] ie pipe Ws JN.1BY m18S N26247| 1262421 gen) | %) IN 6 N52 1224 tebocg| | Pr- Big-Piptz-22-1)) lyn. 168 wy 189 0 iba ge. 126242, ty! Jy 19) 2. e619 2 126 244 192 193 Pw 1262 42. \2b2e, In Pius. 26) 27] pbx 194. NISC by 19b. Jy |i web eqe baer pr-Big~Pipl 2-23-01 Yay JIN. 199, 98 Pos 2G 2: 12.61 4 IN. 199 JH, 200 P. 10 [2G 192 1261321 Le ITN 207 IN, 2 IP 102, 261 2 42617 ees IPT. DUTA UTAMA TEHNIK ABADI [Prepared by [Checked by PRA SWmIARNe jo 47 [es 13/07/2023 - 09:01, ‘Cutting Pipe Material Traceability Report (CPMTA) Page tof. = Prourauramarewmcaao: | TRENCHINSTECHIONAND | sw -Huoorsr scone ten mc ENTRY AUTHORIZATION | gpm aS ee TRENCH INSPECTION AND ENTRY AUTORIZATION FORM sl Location STRuas [Due 20 fo} [20c. Time of aspestion” = Weather Condition: DEY | crew Leader = Dagto Superior: MIgWAN TO [Dimentions: [pent Ne ‘Hozardous Condition Top Ww. . Oo 7 "Ar Sueeng ouom fw fu YO Raw Water Table ‘Soil Type: Tested ow iging Wallis) ‘DSotid Rock, Shale O Yes jo 7. Floor Heaving yy Glaverage Soil Ono nec Frozen Soil Fi Materia aw Super Imposed Load Loose Sand fn Vibrator zi OO... Wet Soil Protection Methods Placenient of Splls& Equipment (Wall MUST be Vertical -No Void) TY... Spoils at Least 2 feet froom edge of trench Shoring og Spoils nt increasing supe imposed oad Titinber F wa “Backhoe aend of trench Pneumatic oo Compressx et. a remote location Ciydratic Ladder Location Biserew fcks (a=) Tcnted in protected area CTrench Shield a. ao Within 25 feet of safe travel ‘Eneven, Irregular Walls ya sv» Seeured E DiTrench Box am .- Extend 36 inches above the tri Stoning _ Mies) Oves) [oy Lend to safe landing ves No Environmental Conditions: Other a Ges Detector C1 Shoring Equip, & Matis Inspected prior to uss? C1 Confined Space Permit ued? FAB temench Sate o Emer? [Comment = Work Order _ [Note = All unsafe condition must be corrected prior to trench entry. any hazardous condition are observed, eke trench must be immediately evacus ‘no one latlowed to re-enter untifeorective scion has been taken [Prepare by © (Checked by : | Approved by: p (8 iS IName MLAS frame Suwean? INaine Iclass, lctass: wi /@E ICisss Jh PTDUTA UTAMA TEHNIK ABADI Pipa Distribusi Gas Area Kawasan Indi PT. BANTENINTI GASINDO PT. DUTA UTAMA TEHNIK ABADI ‘Spoot No Dr-£1G- PiPLZ- z aM ie 12zi3e| l2gse] 14 DT- BS ~ Pipl2.-23- M4] 22s d saa een aren ENTRY AUTHORIZATION ee ORM Be i TRENCH INSVECTION AND ENTRY AUTORIZATION FORM Location CARY AS Date: 21 fof 22. [Time of Inspection = = ge 2 DARTS Supervisor: Mis WAN TO Den > 300 «(Nes No Hazardous Condition Top |W: hs ao > ‘Air Slacking, [Bottom |W: lL: o 7 .. Below Water Table ‘Soil Type Tested OD cvvevnes Bulging Walls) CSolid Rock, Shale O ves ae Floor Heaving Average Soit No ag Frozen Soil x Fill Mater ao ‘Super - Imposed Load Loose Sand oo. Vibrator = nnn, Wet Soil Z Protection Methods “Placement of Spall Equipment (Wall MUST be Vertical - No Void) af ‘Spoils at Least 2 feet from edge of tench Shoring eta sa ‘Spoils not increasing super - imposed load Cimber ea 1 Backhoe a end of trench GPreumatic a o -...0« Compressor, etc. at remote location Citrate Tadder Location DSerew Jacks a @ ‘Located in protected area CiTrench Shield Oo o Within 25 fect of safe travel Eneven, irregular Walls one Seoured Cirench Box oo Extend 36 inches shove the landing sioping pitas Omen joo Lead to safe landing [Wes _No Environmental Condivions: Other TC Gas Detector used? TC) Shoring quip, & Matis Inspected porto use? 1D Contned space Permit issued? CLC ss trench Safe to Enter? [Comment ~ Work Order # [Note All unsafe candiion mont be cored prior to rench entry. Ifany hazardous condition are observed, Je wench rust be immediately evacuned anno one allowed to re-enter untilcorective acion has been taken Prepare "y [checked by Approved by birt— Name MiSs fame SWwJAZNO Name R hutuot Class less WERE [class prelect| LOWERING PIPE SPOOL IM, 209 Ihz0g IN, 210 gy Qu) FRRET es IN £14 F128 FBG = ppen- 23— jn-1$ [PT DUTA UTAMA TEHNIK ABADI Prepared by AR | pay yes 13/07/2023 - 09:01 Cutting Pipe Material Traceability Report (CPMTR) Page tof 1 PT, DUTA UTAMA TEHIIK ABAD! "TRENCH INSPECTION AND | ENTRY AUTHORIZATION FORM. i TRENCH INSPECTION AND ENTRY AUTORIZATION FORM Re Chevas pac: 04. Tuy oF Time of Inspection to SG i [Weather Condition: ao ar. ICrow Leader ~ Supervisor: WL wank. [Dimentions [Depth [ves No. Hazardous Condition To we [ej o_o Tir Stacking Bowom [Wie Ie yo [O @ Below Water Table Soit Type : Tested o 8 Bulging Wall(s) T3Bolid Rock, Shale © Yes (@i Floor Heaving DaAverage Soil O No ao Frozen Soil PFN Material oF Super- imposed Load Loose Sand o@ Vibaior 5 0 Wer Sail Provettion Method: “Placement of Spal ® Equipment (Wall MUST be Feria - No Void) oo is Least 2 Tet oom edge of wench ‘Shoring acy so Spoils ot igeessing sper = imposed Toad Ditimber a Packie a nd of tench OPrewmatic ... Compressor, ote. atremete location Clyrautc Ladder Location Ciserew = ao “Locsin precede Drench Shield ag .«. Within 28 feet of safe (rave! Eneven, Irregular Walls a Scoured = CHiteoch Box TA AW na end 36 leis ion |Sloping M1455 D121 34) a oo Lead to safe landing [Nes _No Environmental Conditions: ‘Other Cl Eh Gas Detecor use? TIL) Storing Equip, & Mais speed ror 1 use? (Confined Space Permit issued? EAC tstrenen Safe to Fer? [comment [aon Work Order ¥ Note: Alf unsafe condition must be corset prior to tench entry. [any hazardous condition are observed, the trench nust be immediately evacuated and no one nied re-enter untcoretveacion has bee ken pare by [Checked by [Aroroved bs Name = Wp Ldap. _|Name : PNAC Name cass [Cass [cas J&| PLDUTA UTAMA TEHNIK ABADI LOWERING PIPE SPOOL PT. OUTAUTAMA TEHNK ABADI os tm {= [pr ie -Pipl2 -72-T11,| 74 [ae 26 JW (26[6~ 40] ¢- ogre 7 a JN \23 IW 12h] 6" gel ¢ oat ly. IN 129 sy 10/640] & oat, Ab bn yet Sv 132 [er aol y oi br - Bie piple-23- tH -[ Vo IN 133 TN 194 16-40] P 07g oF 14 [qu es IN Be [e4olp oso , IN 39 IN 12 8[6"-40]?_ 038 4a. ITN 168 - SN Whole>4olP O77 -blb ~ Pela. 23-111 -[ "Ne aw ai = 4n 142[0-40| r- OF Loe 08 us TN 142-470 149640] 092. [PT. DUTA UTAMA TEHNIK ABADI [Propared by Sanat ee pA 13/07/2023 - 09:01 Cutting Pipe Material Traceabty Report (CPMITR) Sa ENTRY AUTHORIZATION a PT. DUTA UTAMA TEHWIK ABADI ‘TRENCH INSPECTION AND Doon -AMOUTASIIT Fo] Aw FORM homie "TRENCH INSPECTION AND ENTRY AUTORIZATION FORM - HRV AS pae: BS 708 [207 Time of Inspection lwesther Condon: DRA Crew Leader, DARTO Depth frop [we ‘Air Slacking Boum |W: of Below Water Table = Soil Type: oe . Bulging Walls ae. ‘Solid Rock, Shale We o ‘| average Soit No aw. a Caehit Material oe z Eioose Sand F ao = VI iy 2 ow Wet Soil Protection Methods 5 Plocement of Spoils & Equipment (Wall MUST be Fertcal TGR rs Spi af Least 2 fet oom edge of each Shoring og - Spots not increasing supe - imposed foad Ctimber ao Backhoe atend of trench Preumatc con Compressor, ee at remote losaton Cliiyeratic Ladder Location Clscrew Jacks z 01 nnn Located in protected area [Trench shield CD evncns Within 25 feet of safe travel Eneven, Irregular Walls BD... Secured Brench Box wo Extend 36 inches above the landing a stoping Bias) O66) [OG Lead o safe lnding yer _ No Environmental Conditions: ‘Other or sed? (2 Shoring Equip, & Matis specie prior to use? C1” Confined Space Permit fas? CGY trench Sato Enter? [Comment = aoe al Work Order # a a [Note All unsate condition mst be conected prior to cect cacy onto oo be the trench must be immediately evacuated and no one towed to se CIRUAS pas 2170872527 ime of apeton ne Went Condion : PEG [Crew Leader PagTo. Supenisor? MLS WAN PD ise Oars ives No Hazards Condition Te Wee i Air Shocking poem |W: Ib oo Below Water Table Soll Type: Tested ag Bulging Wall) al ‘Solid Rock, Shale MT Yes we Floor Heaving, s Tl Avernge Soil D_No. vy Frozen Soil a i y ‘Super -Ymposed Load at ia Vibrate oO ‘Wet Soil a Placement of Spoils & Fauipment ~ Spoils at Least 2 feet fom edge oF trench Spoils ot increasing supe -inmposed loud 1 Backhoe at end of trench 1 ‘Compresiog, eta remote Joetion Ladder Location w Lesed i pried ea w Within 25 feet of safe travel * i Secured yo ind 36 Tach above hc ending Stoping Cassy niarany | O vn Lead to safe landing es _No | Environment Condon = Other O & Gas Detector used? | Shoring Equip, & Matls Inspected prior to use’? I Confined Space Pei soi? Ei ttreneh Sato Eater? Comment Ts ine Work Order & 2 Rove iT wnt nadion maw te sored prior frock cay any ezadooscondlin sr cbse, sco tb decid Likowed to rote unsecive aco has ben taken Prepare by me, [Checked by [Approved by JAP DUTAUTAMA TEHNIK ABAD! Front = Paaurawscnse rate domme AN Wecancl feria -Concton | Se Er Ce ar PROJECT : ‘DATE “} euewr Locanon Jone arom” no oe Lia tet olay Tost Repel Ne WG Lie No poo! No Joint No a = Peowts DT-BiG PIPL =23} Yay Tyo. Pig +Pi28 bien | fe Me. | 12.000 M08 Crem) lowERING, 1N TO CASING. Bory CROSSING . } } | | 7 eco oy ie = { ne aes) oO” une: QUWARNO « a bression Poston = QS = Wl Poston Pr ouraurawarcicasso: | TRENCHINSPECTIONAND — | dum

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