FORMULR fiber [pone SopourFODDS Frenette Jonoruer 7016 REQUEST FORM pate P TwEQUESTFORW [ag-OBces NUMBER __ 663891 PRONECT NAME |_ WE asser7onrcone qe 8108 Cepceemen. Trantmscion "WOR ORDER HONOUR Tsronovr [318. SROMT mare : SHWE] 2085” CRE SE GENEL tnronnnon NeEDe0 iene oacarren oom [mans _peees mT Fronewivgioo = 7 tt PRIORITY CLASS PLEASE SELECT BY CHECKING ( V) [Janmea 8, dow te Selected must be based on he Prionty Clas tain the SOP ‘Requisition by (signed) : ‘Approved by (signed) a mane Wied name: Burr POSITION: SUPERINTENDENT / SUPERVISOR POSITION pete: ‘not your poston! “atoniionit = Approval must be made and sign by the Superintendent eel the superintendent vl doos not exit LeavelRR, Sick, Perm, ‘or the highest level of department only Supervisor then ‘it thee are no Superintendent Supervisor Level (LeavelRR, Sick, Peri), then approval must go tothe Project ManagecFM. * For requests read to HSEIKL, please complet with requests for completeness of wha ata information is needed (6-3 MSDS, 0S, Data specicalins, et, ‘Writ/Origral Path) = Warehouse presented by the Supervisor. ric Merah Muda): User Supeiendens/ Supervisor jee Gayot pston, and css ou al ‘Green (ou Ma) = UserFORMULIR [Nomor Dokumen MADHANI EQUIPMENT : Equipment Number 76-3108 Equipment Mode Paz0c8 _| Equipment Serial Nunber | 6280064 Component Replace Dess | _Tranemission =a | I WO No. Ref. (043CW1579924-2308 RF No. Ref 63804 ‘ocaton Site WESTPIT 0430 | Hour Meier 7088 ‘COMPONENT REQUESTED : Component Name Transmission Component Part Number | 790825MTWR ‘Component Routable Life jo ov |r" Lite I*Continue” Life MINSNID (aRe-67 ‘SCOPE OF WORK REQUEST : Scheduled J Detail problem : [Joven Tevet onesie Unscheduled Machine Breskdown IDENTIFICATION = } \ REQUEST BY: Name Sudarto [sian [Position Plant Superintendent [pate 29-Aug-23