Equipment Change Request Form

Site ID / Site Name JAW-JK-KYB-1617/CAPITAL_PLACE Location

Tower Provider INTI BANGUN SEJAHTERA Province JABODETABEK
Project Def FT/2884/TRM -074 Position Longtitude 106,81965
New Site ID OL/3G Position Latitide -6,232586111
Purpose HOP JAW-JK-KYB-1617<>JAW-JK-KYB-1575
Skenario Scenario 2.1 (Project REROUTE 2020 )

BTS/Node B Requirement
RBS/Node B Antenna Feeder Remarks by BSS
Outdoor/ New/
No # New/ Ant. Type Ant. Dimen- Ant. Direction Type of Feeder Total Feeder New/
RBS Type Indoor/ No # Enclosure Qty Ant. Height (M) Replace
Cabinet Replace (V-Pol/X-Pol) sion (mm) (deg) Feeder Length X No# Feeder Length (M) Replace
Indoor+Enclosure

Transmission Requirement
Antenna MW Feeder
Feeder
Antenna Ant. Dimen- Ant. Direction New/ New/ Type of Total Feeder New/
Antenna Type Quantity Qty Freq. Height Dimension Length X Number of
Height sion (bearing) Replace Replace Feeder Length (M) Replace
Feeder

MW 1 36 0,3 214,65 NEW 1 23 - - NEW COAX - 75 NEW

Transmission Requirement Power Requirement

TRM Cabinet Remarks by TRM Genset Rectifier Remarks by

Fuel Tank
Power

Type
Outdoor/ Type Capacity Outdoor/ use power
Number Dimension Qty (1000/ Type (A/B/CDC) Quantity
Indoor (Double/CDC) (kVA) Indoor existing
5000L)
-

- - - - - - - - - - -

Civil Requirement
RBS Pad/Shelter Genset Pad Fuel Tank Pad Rectifier Pad TRM Pad Mounting RBS Mounting TRM Remarks by Civil
No #
Dimension Height Dimension Height Dimension Height Dimension Height Dimension Height Yes/No Yes/No
Cabinet
civil OK
- - - - - - - - - - - - No

Issued by ALITA Received by

Dept Engineer Sign Manager Sign Date Dept PIC Sign Manager Sign Date

FAHMI ARDIANSYAH EDY MULYONO 02-Nov-20 INTI BANGUN SEJAHTERA

Approved by Remarks by Tower Provider

Tower Provider Name Signature Date