Document Transmittal Advice

DTA Ref No: BCP- 003

Attention: Mr. Firman and Mr. Nataniel Date:

Christiadi
Company: PT Kaltim Prima Coal From: Fendy JP (PT. Darma Henwa)
Address: M2 Building, Mine Site, Sangatta 75611 Position: Pit B CH22 Bengalon Coal Project
PO.BOX 620 Balikpapan 76106
East Kalimantan, Indonesia

This document supersedes a previous document: Yes / No

Treatment of superseded documents: Please Return / Destroy / Retain and Mark as Superseded

Item Qty. Description of Document Doc No. Rev. ID Copy

No. No.
-
Change Management (CM) jalur lalu lintas di main
1. 1 Set
workshop CH 22 ABLR Pit B
2.
3.
4.
5.
6.

Issued For: Approval / Comment / Q.A / Information / Construction / Other __________________

Controlled by PT DH / Uncontrolled

Comments:

Acknowledgement of Receipt

Please return a copy of this form to the sender immediately:

Received Position: Signed: Date:

The superseded copies of the document are: Returned / Destroyed / Retained and Marked as Superseded

Note: This form is based on an auto-numbered triplicate form. When using this version, the original document is maintained
by PT DH, a copy is given to the recipient who returns a copy acknowledging receipt (if required). All transmittals are
numbered and the numbers recorded on a register.

Prepared By: Systems Manager Date: Document FM-QA-030

Number:
Approved By: Quality Manager Date: Date
Implemented:
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