omar Dokamen = Eto: fon FORM ‘STM-OHS-FRM.O34 orotate "SUMBAWA TIMUR MINING MOBILE EQUIPMENT INSPECTION Halaman = faa) Nomor Revs or SECTION 1 = EQUIPMENT DETAILS Owner / Responsible Company: PT- ACM. Equipment Manufacturer, Model and Description: Nisan _C Pump Truce > Unit / Fleet Number /Vehicle Identification: “ACM BOY Vehicle Registration No: Parmit O6G Project: Mentenonce acces Reaad- Country: (Ndoresea Inspection Location: Laydown Geothermal. Date: 16 Lop [2023 - Inspected By: Am AL Ie MA. biepan - Time: 0g -0 6 Contractors Representative: Ped [rawary Position: rave Breese COMES General Is the mobile equipment’s are registered and isthe registration |, > current? Isa copy of the exploration projects Emergency Response Plan Klee located in the mobile equipment’s cabin? ‘Are Pre-Start inspections taking place prior to the mobile equipment being used? (Check pre-start book is available and i current) Do all mobile equipment receive the preventive maintenance | > recommended by the manufacturer Does modifications to mobile equipment only performed after | formal approval by the manufacturer ? Brakes ‘Are the mobile equipment’ brakes functioning correctly? = Does the brake pedal have a rubber/anti slip pad fitted K 1s the mobile equipment’s park brake operating effectively? - is the mobile equipment equipped with a traction control ABS we braking system? Vehicle Identification 1D Stickers on both sides of vehicle - Height 200mm & Text width 40mm (max 6 digits & max 4 letters, yellow on black) (Mine Site | \~ Spec) Has the mobile equipment been fitted with yellow reflective « stripes on both sides of the operator's cabin? Does the mobile equipment have maximum load and tare | signalling ? Isolation Has the mobile equipment been fitted with a lockable isolation ke switch? Scanned with CamScannerFoR Sruconesrnane Ww. MOBILE EQUIPMENT INSPECTION ‘Owner / Responsible Company: PT ASKMaH Ciwi Mayor Equipment Manufacturer, Model and Description: CAT- 420 Dx Unit /Fleet Number /Vehicle Identification: ACM - B00 Vehicle Registration No: Pua} O82 Project Memkenane Arcus food Na Country: (NOOWOIA Inspection Location: L-oxtlewn Goat-herwol Date: fuli_2023 Inspected By: Cafwdin MM. een Time: 09): 06, Contractors Representative: VEN [PAWwANT Position: (2 Pemlor Meza General EES 1s the mobile equipment’s are registered and is the registration current? Is a copy of the exploration projects Emergency Response Plan located in the mobile equipment’s cabin? zk ‘Are Pre-Start inspections taking place prior to the mobile equipment being used? (Check pre-start book is available and current) Do all mobile equipment receive the preventive maintenance recommended by the manufacturer Does modifications to mobile equipment only performed after formal approval by the manufacturer ? Brakes “Fre the mobile equipment’s brakes functioning correctly? Does the brake pedal have a rubber/anti slip pad fitted i Ts the mobile equipment’s park brake operating effectively? S Ts the mobile equipment equipped with a traction control ABS braking system? Vehicle Identification TD Stickers on both sides of vehicle - Height 200mm & Text width ‘40mm (max 6 digits & max 4 letters, yellow on black) (Mine Site Spec) Has the mobile equipment been fitted with yellow reflective stripes on both sides of the operator's cabin? Does the mobile equipment have maximum load and tare signalling ? Isolation Tias the mobile equipment been fitted with a lockable isolation switch? rate ae Ta reo Eee Tine —| so Yeas sO nat 3 Scanned with CamScannerForm Srurons rra3e sauna e = MOBILE EQUIPMENT INSPECTION ‘Owner / Responsible Company: /Acrn a Cun ay Equipment Manufacturer, Model and Description: A/#M/O 500. Unit /Fleet Number /Vehicle identification: ACI B Coe. Vehicle Registration No: DT QIGt UE Project: MNatntenence Country: /tikone sia Inspection Location: flame -emrer Meu Stay (A_| date: 19-07- L028 Inspected By: filamkiman 7 U; ran Time: 906 Contractors Representative: Dyyly’ [foul Position: QMIWEr— OT Paar aN ENE General Te the mobile equipments are registered andisthe regiraton | 7 current? 15 a copy of the exploration projects Emergency Response Plan x located in the mobile equipment’s cabin? ‘Are Pre-Start inspections taking place prior to the mobile ‘equipment being used? (Check pre-start book is available and current) Do all mobile equipment receive the preventive maintenance recommended by the manufacturer ‘Does modifications to mobile equipment only performed after formal approval by the manufacturer ? Brakes SINUS ‘Are the mobile equipment’s brakes functioning correctly? Does the brake pedal have a rubber/ar ip pad fitted Ts the mobile equipment’s park brake operating effectively? NISIN Is the mobile equipment equipped with a traction control ADS braking system? x ‘Vehicle Identification TD Stickers on both sides of vehicle - Height 200mm & Text width 40mm (max 6 digits & max 4 letters, yellow on black) (Mine Site Spec) Has the mobile equipment been fitted with yellow reflective x stripes on both sides of the operator's cabin? Does the mobile equipment have maximum load and tare signaling ? i v isolation %. Has the mobile equipment been fitted with a lockable isolation eae x Scanned with CamScanner