Project

i-III Application for Witness of Inspection & Tests

Work No. BA122400

To be filled by VENDOR
Applicant : Date issued: 27 March 2020
Person in Charge : Ibnu Hanafi Department : Engineering
E-Mail: ibnu@bukakainti.com Tel/Telefax : 021 5482941
Place of Inspection (Name of Vendor/Manufacture/Work Shop):

Marunda Center Blok E7 No A & B,

Jl. Marunda Makmur, Sagara Makmur, Kec. Tarumajaya, Bekasi
Jawa Barat 17211

Purchase Order No. : PD-A00-ROT-POP-AYGC001

Order
Description : Chilled Water Refrigerator
Items
Contract Delivery Date : March 13, 2020
Vendor Design/Fab. Drawing : ( ) Approved as Noted(AN) (X) Approved(App)
Doc/DWG
Status Inspection/Test Plan : ( ) Approved as Noted(AN) ( ) Approved(App)
Witness Kind of Inspection & Tests Inspection Items (Item No) and Qt’y Date and Time of Witness
Application Visual Check
UQ-2150 Date: 30 March 2020
AM: 10.00 PM:
Qty = 1 unit Date:
AM: PM:
Date
AM: PM:
Date:
AM: PM:
Note:
ITP cant be submit by the factory

To be filles by CONTRACTOR (Intent & Confirmation of Witness Attendance )

To: E-Mail: Fax:
Kindly inform us of your intention for the above witness attendance by return, marking ( x ) where applicable:
( ): Yes, we will attend the witness * Confirmed herein as per the mark (x).
- CONTRACTOR’s Attnedant Date
(Name) :

- Nominated Third Party,if any: Signed

( ): No, we will waive attendance to the witness. (Name)
VENDOR to proceed.

To be filles by OWNER (Intent & Confirmation of Witness Attendance )

To: E-Mail: Fax:
Kindly inform us of your intention for the above witness attendance by return, marking ( x ) where applicable:
( ): Yes, we will attend the witness * Confirmed herein as per the mark (x).
- OWNER’s Attnedant (Name) : Date

- Nominated Third Party,if any: Signed

( ): No, we will waive attendance to the witness. (Name)
CONTRACTOR to proceed.