CERTIFICATE OF INSPECTION

No. LDS/KP/0734-01-BPN/IX/2021

That the undersign of PT LD Servis, did at the request of PT Elnusa Tbk has been carried out inspection
of “Pressure Safety Valve”, are as follows :

Owner : PT Elnusa Tbk

Name of Equipment : Pressure Safety Valve
Serial Number : A01276
Manufacturer : Sata Valve
Model : N-120s
Type : Conventional
Design Press. / MAWP : 120 Psig
Equipment Protect : Air Tank
Type of Inspection : Annual Inspection
Location of Inspection : PT LD Servis Shop - Balikpapan
Date of Inspection : September 9, 2021
Reference Code : API 526, API 527, ASME VIII
Inspection Item : 1. Physical Inspection
2. Function Test
3. Popping Test
4. Leak Test
The inspection result are stated bellow:
No. Description Tag Number Set Pressure Result
½” Pressure
1. PSV - 01 110 Psig Acceptable
Safety Valve

Suggestion : - Record of maintenance, modification or alteration of this

equipment should be attached on this document.
- Periodical Inspection of the above equipment should be
conducted in interval 1 (one) Years

Conclusion : Based on inspection result, the equipment above found in order

and can be used accordingly.
Expired Date : September 9, 2022

Balikpapan, 25 November 2021

PT LD Servis

Ronni ST
Tech. Insp. Manager

LD-F-OPR-COI-04.09 Rev.01
HEAD OFFICE : WORKSHOP :
Jl. MT Haryono Gang PLN No. 15 Jl. Sosial Dalam No. 32 RT. 014
Balikpapan – Kalimantan Timur Lamaru, Balikpapan Timur
Tlpn: (0542) 878709 Kalimantan Timur 76116

website : www.ldservis.com
 Pressure Safety Valve (PSV) Data
Report No. : LDS-0734-ELN-01
Client : PT Elnusa Tbk
Spec / Std Used : Customer Requirement
Date of Services : September 9, 2021
Location of Service : PT LD Servis Shop - Balikpapan
Tag no. : PSV - 01
Manufacturer : Sata Valve
PRV Type / Model No. : Conventional / N-120s
Size : 1/2" X 1/2 " (inch )
Year Manufacture / Used : N/A / 2021
Required Capacity : - Psig
PSV Capacity : 120 Psig / 8.451 Kg/Cm²
P&ID Number : N/A
Data Sheet Number : N/A
Equipment Protected : Air Tank
Design Press. / MAWP : 120 Psig / 8.451 Kg/Cm²
Operation Pressure : 110 Psig / 7.746 Kg/Cm²
Operation Temp. : Ambient
Fluid : Air
PSV Pop Testing Result
Setting Pressure : 110 Psig / 7.746 Kg/Cm²
Back Pressure : 0 Psig / 0.000 Kg/Cm²
CDTP : 110 Psig / 7.746 Kg/Cm²
Leak Test Pressure : 108 Psig / 7.606 Kg/Cm²
Test Media : Nitrogen (N)
Leak Test Comment : No Leakage
PSV Final Pop Testing Result
Final Pop Pressure : 110 Psig / 7.746 Kg/Cm²
Final Leakage Pressure : 0.5 Bubble/Minutes
Final Rating Setting : 5 mm
Final Setting Pressure : 110 Psig / 7.746 Kg/Cm²
PSV Component Condition
Body : Good Condition Disc Holder : Not Available
Pilot : Not Available Connection end inlet : Good Condition
Bellows : Not Available Connection end outlet : Good Condition
Bonnet : Good Condition Lower Ring : Not Available
Gasket : Not Available Nozzle : Not Available
Guide : Not Available Spring : Good Condition
Disc : Good Condition Spindle : Good Condition

Comment ;

Name of person inspect and

Reviewed By: Client's Representative Approved
making this report:

Waluyo Sugito Ronni ST

PSV Inspector Supervisor PT Elnusa Tbk
LD-F-OPR-COI-04.09 Rev.01
 Pressure Safety Valve (PSV) Data
Report No. : LDS-0734-ELN
Client : PT Elnusa Tbk
Spec / Std Used : Customer Requirement
Date of Services : September 9, 2021
Location of Service : PT LD Servis Shop - Balikpapan
Tag no. : PSV - 01
Manufacturer : Sata Valve
PRV Type / Model No. : Conventional / N-120s
Size : 1/2" X 1/2 " (inch )
Year Manufacture / Used : N/A / 2021
Required Capacity : - Psig
PSV Capacity : 120 Psig / 8.451 Kg/Cm²
P&ID Number : N/A
Data Sheet Number : N/A
Equipment Protected : Air Tank
Design Press. / MAWP : 120 Psig / 8.451 Kg/Cm²
Operation Pressure : 110 Psig / 7.746 Kg/Cm²
Operation Temp. : Ambient
Fluid : Air
PSV Pop Testing Result
Setting Pressure : 110 Psig / 7.746 Kg/Cm²
Back Pressure : 0 Psig / 0.000 Kg/Cm²
CDTP : 110 Psig / 7.746 Kg/Cm²
Leak Test Pressure : 108 Psig / 7.606 Kg/Cm²
Test Media : Nitrogen (N)
Leak Test Comment : No Leakage
PSV Final Pop Testing Result
Final Pop Pressure : 110 Psig / 7.746 Kg/Cm²
Final Leakage Pressure : 0.5 Bubble/Minutes
Final Rating Setting : 5 mm
Final Setting Pressure : 110 Psig / 7.746 Kg/Cm²
PSV Component Condition
Body : Good Condition Disc Holder : Not Available
Pilot : Not Available Connection end inlet : Good Condition
Bellows : Not Available Connection end outlet : Good Condition
Bonnet : Good Condition Lower Ring : Not Available
Gasket : Not Available Nozzle : Not Available
Guide : Not Available Spring : Good Condition
Disc : Good Condition Spindle : Good Condition

Comment ;
 Detail Picture Of Pressure Safety Valve

Name of person inspect and

Reviewed By: Client's Representative Approved
making this report:

Waluyo Sugito Ronni ST

PSV Inspector Supervisor PT Elnusa Tbk
LD-F-OPR-COI-04.09 Rev.01