Civ Sor 0012

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Doc. No.

:
CLIENT: INTERPORT
TPEC-9750-QC-0006

PLANT LOCATION : KARIANGAU, BALIKPAPAN


Revision:
00

PROJECT TITLE: EMILY 1 PROJECT FUEL TERMINAL Date:


AND JETTY 21-FEB-2019

SITE OBSERVATION REPORT


Area: Polyclinic Building Report No.: 9750-CIV-SOR-0012 Date: 17th November
2019

Issued To Discipline PT. Bahana Cipta Person In-charge Mr. Saoki


Internusa

Observation Description:
Lean Concrete Already executed before submission of RFI DCP Test & RFI Prepouring Lean Concrete

Page 1 of 3
Doc. No.:
CLIENT: INTERPORT
TPEC-9750-QC-0006

PLANT LOCATION : KARIANGAU, BALIKPAPAN


Revision:
00

PROJECT TITLE: EMILY 1 PROJECT FUEL TERMINAL Date:


AND JETTY 21-FEB-2019

SITE OBSERVATION REPORT


Photographic Evidence of Initial Findings (where applicable)

Lean concrete On Polyclinic Building Already poured before submission of RFI

Page 2 of 3
Doc. No.:
CLIENT: INTERPORT
TPEC-9750-QC-0006

PLANT LOCATION : KARIANGAU, BALIKPAPAN


Revision:
00

PROJECT TITLE: EMILY 1 PROJECT FUEL TERMINAL Date:


AND JETTY 21-FEB-2019

SITE OBSERVATION REPORT


Recommended Actions: Resubmit RFI for this issue and Testing report Of DCP

Name Signature Date Designation

Completed by

Verification / closeout

Issued By Closed By

Name Rafael M Iskandar Name

Signature RMI Signature

Designation QC Civil Inspector Designation

Date 17th November 2019 Date

Evidences enclosed (if available): Yes  No

Page 3 of 3

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