PT SGS Indonesia

Cilandak Commercial Estate #108C

Cilandak, Jakarta Selatan INSPECTION REPORT
Indonesia, 12560
+62 21 7818111 01/IR/LMB/17
Inspection report No:
September 19th, 2017
Report submission date:

Internal Work Order

Inspection Instruction
Lumut Balai Geothermal
A. Project: B. Supplier: PT. JEL
Power Plant
Project Ref. No.: Details:
P.O. Ref No: Job No.:
C. Inspection D. Sub-
Visual N/A
: Supplier:
Customer Ref.No.: Details:
Int. Ref. No. (EA): Job No.:
F. Place of Palembang – South Sumatra
E. Customer:
Inspection:
Mr. Baskoro (QC)
Country: Indonesia Contact Person:
Rumah Makan Sekar Kuring
Jl.Tg. Api-api km.6 Desa Gasing,
Customer Ref. No.: Address:
Kecamatan Talang. Kabupaten
Banyuasin – Sumatra Selatan
Phone/Fax: 082210405755
G. Executing SGS Email-Address: Gurit.baskoro@toshiba.co.jp
PT SGS INDONESIA
office data:
Country: Indonesia P.O. at supplier: N/A
Coordinator: Mr. Sandhy Sipayung

H. Inspection Type: Spot inspection Project inspection

Pre-production During prodution Pre-Shipment

I. Scope of Work: Requested

Performed Comments
inspect Witness review
According to the approved ITP No.

Pre-Shipment Inspection
Hydrostatic Test
Pre-Inspection Meeting
Final Testing/Inspection
Others
Others: (as specified):
Further description:

J. Equipment/Goods 22 Pipe Deviations during

Requested for Inspection: inspection:
NO
(if yes, see report details)
K. Applicable Norms, API 5L Verified during
Standards and inspection:
specifications:

Rev. Attached to At place of Document

L. Referenced Documents: Reference No.
No. request inspection used
Purchase Order
Purchase Order Specifications
Purchasers Standards
Data Sheet / Packing List
Approved Drawings
Inspection Test Plan
Test Procedures
Weld Procedures Specifications

ISR V0.1/ZP „496512397.doc“

 PT SGS Indonesia
Cilandak Commercial Estate #108C
Cilandak, Jakarta Selatan INSPECTION REPORT
Indonesia, 12560
+62 21 7818111 01/IR/LMB/17
Inspection report No:
September 19th, 2017
Report submission date:

Weld Procedure Approval

Certificates
Welder Approval Certificates
Operational/Functional Test
Procedures
NDE Procedures
Post Heat Treatment Procedure
Others

M. Inspection Dates: September 18th, 2017

N. No.of inspection man days:
(based on 8h)
1 (one) day

O. Inspection Result: satisfactory P. NCR/Punch list

conditionally accepted (see reportdetails) issued:
non conforming(see report details) No
repair(see report details) Yes
aborted inspections (see report details) (see report details)

Q. Inspection Summary and Total progress inspection of pipe 22 pc, 21 pc accepted, 1 pc rejected
Short Conclusion:

Inspector: Mr. Hendri Nasril Date: September 18th, 2017

Reviewer: Mr. Sandhy Sipayung Date: September 19th, 2017

R. Report Details

R.1. Attendees
Mr. Hendri Nasril ( PT SGS Indonesia – Site Inspector )
Mr. Baskoro ( PT.TOSHIBA – QC )
Mr. Eko Utomo ( PT. IKPT )

R.2. Documents Used

- Purchase Specification
- Method statement

R.3. Equipment / Goods Inspected

- 22 pipe

R.4. Inspection activities and Results

INSPECTION PERFORMED AND RESULT
Visited PT. JEL, Palembang to do Visual inspection of Pipe and review documents
The purpose of this visit is to check and verify the quantity progress up to date of visit

The item which is inspected are the following:

 22 pc ( pipe )

Inspection result and summary as below:

 Total progress inspection of pipe 22 pc,
 21 pc accepted
 1 pc rejected
ISR V0.1/ZP „496512397.doc“
 PT SGS Indonesia
Cilandak Commercial Estate #108C
Cilandak, Jakarta Selatan INSPECTION REPORT
Indonesia, 12560
+62 21 7818111 01/IR/LMB/17
Inspection report No:
September 19th, 2017
Report submission date:

For the detail result please see the attachment .

Inspection description Result

R.4.1. Witness
Check Thicknes of material after grinding Conditionally accepted

R.5. Non Conformities

Dent material ( 1 pipe, Dia 16”, Thk 9.53 mm )

R.6. Actions required

Quarantine

R.7. Conclusion
Total progress inspection of pipe 22 pc,
21 pc accepted, 1 pc rejected

Prepared by: Mr. Hendri Nasril Reviewed by: Mr.Sandhy Sipayung

Signed: Signed:

Date of reporting: September 18th, 2017 Date of reporting: September 19th, 2017

R.8. Attachments
- Pipe spool daily progress

S. Inspection Photos

ISR V0.1/ZP „496512397.doc“

 PT SGS Indonesia
Cilandak Commercial Estate #108C
Cilandak, Jakarta Selatan INSPECTION REPORT
Indonesia, 12560
+62 21 7818111 01/IR/LMB/17
Inspection report No:
September 19th, 2017
Report submission date:

PT JEL LAY DOWN AREA

GRIND AFTER MARKING CHECK THIKNESS FROM INSIDE BY UTG

DEFECT LOCATION ( DENT ) IDENTIFIED OF MATERIAL REJECTED

ISR V0.1/ZP „496512397.doc“

 PT SGS Indonesia
Cilandak Commercial Estate #108C
Cilandak, Jakarta Selatan INSPECTION REPORT
Indonesia, 12560
+62 21 7818111 01/IR/LMB/17
Inspection report No:
September 19th, 2017
Report submission date:

This document is issued by the Company under its General Conditions of Service accessible at http://www.sgs.com/terms_and_conditions.htm. Attention is
drawn to the limitation of liability, indemnification and jurisdiction issues defined therein.

Any holder of this document is advised that information contained hereon reflects the Company’s findings at the time of its intervention only and within the limits of
Customer’s instructions, if any. The Company’s sole responsibility is to its Customer and this document does not exonerate parties to a transaction from
exercising all their rights and obligations under the transaction documents. Any unauthorized alteration, forgery or falsification of the content or appearance of this
document is unlawful and offenders may be prosecuted to the fullest extent of the law.

THE ABOVE REFLECTS OUR FINDINGS AT TIME AND PLACE OF INSPECTION. THIS REPORT DOES NOT
RELEASE BUYERS OR SELLERS FROM THEIR CONTRACTUAL RESPONSIBILITIES NOR DOES IT
PREJUDICE BUYER’S RIGHT OF CLAIM TOWARD SELLERS/SUPPLIERS FOR COMPENSATION FOR ANY
APPARENT AND/OR HIDDEN DEFECTS NOT DETECTED DURING OUR INSPECTION OR OCCURRING
THEREAFTER.

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