540 0001 2001

Revision 0
11 November 2021

REQUEST FOR INSPECTION

Project Title : JTB Tie-In Project
Job No :
Client : ExxonMobil Cepu Ltd Date : 11 November 2021
Main Contractor : Supraco Indonesia Report No. : SPC-EIT-21-10-2021-0008
Sub-Contractor : - Page : 1 of 1

To : QC Representative of EMCL
Attn. : Mr. Sahlaa

Gentlemen,
We would like to have your presence for inspection according to the following schedules.

Date and time : 11-Nov-21 / 9:00 AM

No. Inspection Item Place/Area Remarks

1 I-IJBA 999511-50-PCS EA 1700
2 I-VJBD 999511-50-PCS EA 1700
3 I-VJBD 999511-50-PCS EA 1700
4 I-VJBA 999511-50-PCS EA 1700
5 I-VJBA 999511-50-PCS EA 1700
6 I-VJBA 999511-51-FC EA 1700
7 I-VJBA 976522A-50-FC EA 1700
8 I-VJBA 976522A-50-FC EA 1700
9 I-IJBA 418529-50-FCS EA 1700
10 I-VJBD 976522A-50-FC EA 1700
11 I-VJBD 976522A-50-FC EA 1700
12 I-VJBD 976522A-51-SIS EA 1700
13 I-VJBA 523500-50-PCS EA 1700
14 I-IJBD 976522A-50-SIS EA 1700

Electrical V Instrument V Telecommunication Other

COMMENT :

Witnessed/Reviewed by, Reviewed/Approved by,

QC Supraco Indonesia ExxonMobil Cepu Ltd

M. Urfaa F. Purnomo Mr. Sahlaa

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