FOR CONSTRUCTION

APPROVED
by OE
01-Mar-22

1 15.FEB.2022 Jongpyo, Kim Choulho, Hwang Soowon, Lee FOR CONSTRUCTION

0 04.FEB.2022 Jongpyo, Kim Choulho, Hwang Soowon, Lee FOR CONSTRUCTION
B 22.JAN.2022 Jongpyo, Kim Choulho, Hwang Soowon, Lee FOR APPROVAL
A 10.DEC.2021 Jongpyo, Kim Choulho, Hwang Soowon, Lee FOR APPROVAL
REV DATE PREPARED CHECKED APPROVED STATUS
Owner
CEO OFFICE

ACKNOWLEDGED
AND
SIGNED
Owner’s Engineer Date: Mar 01, 2022

Contractor b

Approved
by IRT on Mar 01, 2022

Sub-Supplier

Project
ASH HANDLING FACILITIES FOR
JAWA 9 & 10 COAL FIRED STEAM POWER PLANT
Document Title

FIELD ITP FOR EARTH WORK FOR ASH HANDLING FACILTIES

Document Type
□ Basic Engineering Document □ Detail Engineering Document □ Vendor Document ■ Other

Document No.

J910-DH02-P10ZEN-040001
 Ash Handling Facilities For Jawa 9&10 Coal Fired Steam Power Plant_ITP Review Comment Sheet
From : DHII Mr. Jongpyo.kim
To : OE Mr. Iskandar Jamil Comment Sheet Document No : J910-DH02-P10ZEN-040001_CS
cc : OE Mr. Yusri Yaakob
Dwg Title : Field ITP for Earth Work for Ash Handling Facility
Dwg No : J910-DH02-P10ZEN-040001
Purpose : FC

Review Category
A = Approved
B = Approved with comments, forward final document
C = Not Approved
I = Accepted for reference (For information only)

No. Rev. Sheet/ Page/ Sect. O/E Comments Consortium Response Status
Please rename this ITP as "Field ITP for Earth Work for Ash Handling
1 A 1 Repaired Closed
Facilities".

Preparation work
This content should be mentioned in Method Statements and it is not
2 A 7/1 Closed
to verify area/land not dispute condition, no any clash other found applicable to ITP.
facilities, no negative affects to another work/subject.

Please add "Verification of Relevant Documents" which should be done

before commencement of works.

1.0 Verification of Relevant Documents

3 A 7/1 Repaired Closed
1.1 AFC Drawing
1.2 Method Statement & Risk Assessment
1.3 Equipment & Machineries
1.4 Calibration Certificate
4 A 7/2 add clearing and grabbing Repaired Closed
Any others Instruments & Inspection tools will used for Earth Works
5 A 7/2 Activity, if YES please mention the Instruments & Inspection Tools will be Only survey equipment will be used for cutting work. Closed
used
This content should be mentioned in Method Statements and it is not
6 A 7/2 Add drainage system Closed
applicable to ITP.
7 A 10/5 Please change to "100% (after completion of works)" Repaired Closed
 This content should be mentioned in Method Statements and it is not
8 A 10/5 add disposal work procedure. Closed
applicable to ITP.

9 0 2 EPC should add CRS from the previous revision. Repaired Closed

Please revise only state

10 0 11,12,13 IRT/OE Repaired Closed
"affected for all pages inspection forms"
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
J910-DH02-P10ZEN-040001

RECORD OF REVISION
Rev. Date Page Affected Description of Revision

A 10.DEC.2021 First Issue

B 22.JAN.2022 1, 7 , 10 Second Issue

0 04.FEB.2022 - Third Issue

1 15.FEB.2022 11,12,13 Fourth Issue

Rev.1 2 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
J910-DH02-P10ZEN-040001

CONTENTS

1. INTRODUCTION .......................................................................................................... 4
1.1 Inspection and Test Plan (ITP) ............................................................................................................ 4
1.2 Acceptance Conditions ......................................................................................................................... 4
1.3 Request for Inspection and Test (RFI) .............................................................................................. 5
1.4 Documentation ........................................................................................................................................ 5
2. FLOW CHART OF THE INSPECTION..................................................................... 5
2.1 General Inspection Flow Chart ........................................................................................................... 5
2.2 Flow Chart for Field Inspection of Earth Works ........................................................................... 6
3. DETAIL ITP FOR EARTH WORK ............................................................................ 7
4. APPENDICES............................................................................................................... 11
APPENDIX 1......................................................................................................................................... 11
Form No. ITP-C-0001-09 INSPECTION FOR SURVEYING RECORD REPORT ....... 11
APPENDIX 2......................................................................................................................................... 12
Form No. ITP-C-0001-10 INSPECTION FOR EXCAVATION RECORD REPORT ..... 12
APPENDIX 3......................................................................................................................................... 13
Form No. ITP-C-0001-11 INSPECTION FOR BACKFILL RECORD REPORT ........... 13

Rev.1 3 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
J910-DH02-P10ZEN-040001

1. INTRODUCTION
1.1 Inspection and Test Plan (ITP)

a. Scope
The Inspection and Test Plan (ITP) is an engineering document, which described the inspection
and tests to be performed. The inspection is performed in accordance with Owner specification
requirements and specified codes & standards.
b. Composition
This ITP is composed as belows:
- Cover Sheet with project name, Owner name, application and related personnel's name.
- Introduction with general notes
- ITP with Inspection and test activities

1.2 Acceptance Conditions

a. The equipments, materials are inspected and tested at Site in confirmation of the conditions
specified in the ITP. Each operation refers to the whole or part of a standard, a technical
specification and a regulation.
b. Detailed Legend
Detailed Legend for Inspection activity points shall be designated on the ITP by the related
parties as follows;
P : Performance Point. Responsible to perform or execute the actual works.
R : Record/review Point. Responsible for Generating record/review.
W : Witness Point. Consortium shall send a notification to the Owner prior to perform
the related test or inspection. If the Owner fails to be present, the test or inspection
may be carried out by Consortium without witness of the Owner.
SW : Spot Witness Point. The spot witness point that is handled like as a sample witness
point, it will be witnessed by related parties only for several activities/ item to be
inspected. But, if inadequate working procedures are detected by related parties,
this point will be treated as witness points after the proper action.
S : Surveillance Point. Random attendance at site, no signature required on the
Inspection Request ( IR ) or its accompanying documentation.
H : Hold Point. Consortium shall also send a notification to the Owner prior to perform
the related test or inspection. If the Owner fails to be present, any construction
activities shall not be proceeded by Consortium without attendence or any written
approval of the Owner.

Rev.1 4 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
J910-DH02-P10ZEN-040001
1.3 Request for Inspection and Test (RFI)

a. RFI will be issued by Consortium through Aconex at least three (3) days in advance for
site/field inspection and 7 days for outside inspection. For overseas inspection, RFI shall be
issued 35 days in advance prior to the inspection and test in accordance with the Contract.
b. RFI is required for all action points excluding Surveillance Point.
c. RFI will contain as a minimum of the following details:
- ITP No./Drawing No./Equiment name/System Name
- Inspection tem/activities on the ITP to be inspected
- Inspection date and time
- Unit No./Area/Building/Location/Elevation
- Any comments to be considered

1.4 Documentation

a. The results of inspections and tests shall be documented in writing and signed by the related
parties as a token of approval
b. Signed documents shall be controlled as a QA records in accordance with the related procedure.
c. Photos related to the work. Minimum captured: before test/inspect, on progress, after.

2. FLOW CHART OF THE INSPECTION

2.1 General Inspection Flow Chart

SHOP / MANUFACTURER

Engineering Purchase Order Fabrication and Owner Witness Transport,

Design Issue to Manufacturing Inspection as Shipping &
Information as Supplier (PO) in shop per approved Pass Customs
per Contract ITP

Move to Material &

Warehouse Inspection at Warehouse as per Accept Laydown area Equipment to
Receiving Packing list. or Warehouse be released to
point at Site as per Storage Site
Receiving Inspection report Issue. Levels Construction

Package damaged Re-packing Reject

Inspection
Open box Issue HOLD activity as per
Inspection to Tag & NCR approved ITP
check package
inside

SITE

Rev.1 5 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
J910-DH02-P10ZEN-040001
2.2 Flow Chart for Field Inspection of Earth Works

Inspection Inspection tests Inspection of Survey Approval for

Request for plan as per coordinate points and back filling &
Survey and approved ITPs Level as per approved Materials as per
Earthwork drawings ITPs

Witnessing and Not Final

testing for back satisfactory/Failed Inspection as
filling as per instruction for per ITPs
ITPs recompacton/Redo

Rev.1 6 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
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3. DETAIL ITP FOR EARTH WORK

Verification Inspection and Test Activities by
Inspection / Test Items Applied Procedure, Frequency of
Document (QC Acceptance Criteria
No. Description Code, DWG, etc. Inspection / Test
Record)
Sub-Con EPC IRT/OE Auth.
1 VERIFICATION OF RELEVANT DOCUMENTS
Comply with Approved
Comply with Contract &
1.1. AFC Drawing DWG, CODE and AFC Drawings Design Criteria
As per Report P R R
Standard
Contract Book 4,
1.2. Method Statement & Method Statement Comply with Approved
Method Statement As per Report P R R -
Risk Assessment &Risk Assessment Method Statement.
Equipment &
Equipment & Machinery Comply with Approved
1.3. Equipment & Machineries Machineries As per Report P R R -
certificates inspection records
inspection records
Method Statement, Comply with Approved
calibration
1.4. Calibration Certificate Instrument specification, Valid calibration As per Report P R R -
certificates
Calibration Procedure certificates
2 Cutting (clearing & grabbing)

2.1. Instrument Calibration Calibration As per the

for Surveying Equipment Certicate calibration report
P R R -
Contract Book 4.
Chapter 4. Attachment
of Design Specifications As per approved
2.2. Line & Grade ITP-C-0001-10
drawings
P W SW -
2.Technical
Specifications for Civil
Works Before Slope
2.3. Soil condition of slope Lab Report
protection
P W SW -
2.1 Earth Works, Comply with contract
Approved For specification, Approved
Construction Drawings drawings
as No. : J910-XB02-
P10ETH-165403 to 06
2.4. Final Survey (as per Approved Method Before proceeding
DWG attached, Statement. With Doc. ITP-C-0001-09
slope protection
P W SW -
drainage system) No. : J910-DD09-
P3UMA-728223

Rev.1 7 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
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Verification Inspection and Test Activities by

Inspection / Test Items Applied Procedure, Frequency of
Document (QC Acceptance Criteria
No. Description Code, DWG, etc. Inspection / Test
Record)
Sub-Con EPC IRT/OE Auth.

3 Excavation

3.1. Instrument Calibration for Calibration As per the

Surveying Equipment Certicate calibration report
P R R -

Contract Book 4.
Chapter 4. Attachment As per approved
3.2.Line & Grade
of Design Specifications
ITP-C-0001-10
drawings
P W SW -
2.Technical
Comply with contract
Specifications for Civil
specification, Approved
Works
drawings
2.1 Earth Works,
3.3. Soil condition at the bottom of AFC Drawings, Before pouring
excavation
Lab Report
Lean concrete
P W SW -
Approved Method
Statement

Before pouring
3.4.Dewatering (if water rises) ITP-C-0001-10
Lean concrete
P W SW -

Before proceeding
3.5. Final Survey ITP-C-0001-09
rebar works
P W SW -

Rev.1 8 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
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Verification Inspection and Test Activities by

Inspection / Test Items Applied Procedure, Frequency of
No. Document (QC Acceptance Criteria
Description Code, DWG, etc. Inspection / Test
Record)
Sub-Con EPC IRT/OE Auth.

4 Backfilling

ITP-C-0001-11 or Once in Every

4.1. Material Check P W SW -
Lab. Report sources of materials
Contract Book 4.
Chapter 4. Attachment
of Design ITP-C-0001-11 or Once in Every
a) Soil Classification P W SW -
Specifications Lab. Report sources of materials
2.Technical Comply with contract
Specifications for Civil specification, Approved
ITP-C-0001-11 or Once in Every
b) Sieve Analysis Works P W SW -
Lab. Report drawings and ASTM sources of materials
2.1 Earth Works,
D1557 & D2049
Approved Method ITP-C-0001-11 or Once in Every
c) Liquid Limit P W SW -
Statement and ASTM Lab. Report sources of materials
D1557 & D2049
ITP-C-0001-11 or Once in Every
d) Plasticity Index P W SW -
Lab. Report sources of materials

ITP-C-0001-11 or
e) Moisture Content Every 1000 Cum P W SW -
Contract Book 4. Lab. Report
Chapter 4. Attachment
of Design
4.2. Layer Thickness Specifications ITP-C-0001-11 Every 1000 Cum P W SW -
2.Technical
Comply with contract
Specifications for Civil
specification, Approved
Works
drawings and ASTM
2.1 Earth Works,
D1557 & D2049
Field Density Test
4.3. Compaction Test Procedure and ASTM ITP-C-0001-11 or
a) Field Density & Moistire D1557 & D2049 Every 1000 Cum R W W -
Lab. Report
Test

Rev.1 9 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
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Verification Inspection and Test Activities by

Inspection / Test Items Applied Procedure, Acceptance Frequency of
No. Document (QC
Description Code, DWG, etc. Criteria Inspection / Test
Record)
Sub-Con EPC IRT/OE Auth.

5 Final Conformity / Final Walkdown Inspection

Contract Book 4.
5.1. Check completeness of Chapter 4. Attachment
Works of Design P H H
Specifications
2.Technical Punch List
5.3. Punch List Registration Comply with contract s 100 % (after
& Clearance Specifications for Civil pecification, completion of P H H
Works Approved drawings works)
2.1 Earth Works,
5.4. Issuance of Mechanical AFC Drawings,
Completion Certificate Approved Method Stat
(MCC) ement MCC P H H

Site Work
All Inspection and Test Reviewed & signed-off
6 Final Review of Documentation
Records
Conformance File
by all parties
100 % (All records) R R R -
(SWCF)

Note:
1) Related Method Statement will be attached along with the RFI
2) Related drawing will be attached along with the RFI

Legend Definition: P Perform R Record Review

H Hold Point Sub-Con Subcontractor (HANS JAYA)
W Witness EPC Contractor (DHI)
SW Spot Witness IRT/OE Owner (Indo Raya Tenaga) / Owner Engineer
Auth. Authorized third party for the specific item as applicable

Rev.1 10 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
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APPENDICES
APPENDIX 1
Form No. ITP-C-0001-09 INSPECTION FOR SURVEYING RECORD REPORT

INSPECTION FOR SURVEYING RECORD

REPORT (FOR EARTH WORK)

Structure : _____________________ Report No. : _____________________

Area/Unit : _____________________ Date : _____________________
Location : _____________________ Subcon : _____________________
: ASH Handling Facilities For Jawa 9&10
Project Reff.Dwg. : _____________________
CFSPP Project
Ref. Std. : _____________________
Inspection Result Acceptance
Check Items Remarks
Accept Reject Criteria
A. Description & Location

As per
approved
drawings

B. Benchmark used

As per
approved
drawings

C. Surveying data

As per
approved
drawings

Note :

Submitted by Checked by Inspected by

IRT/OE
Sub-con Sign/Date Construction Sign/Date QC Inspector Sign/Date Sign/Date Sign/Date
(Rep.) (IRT)

Rev.1 11 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
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APPENDIX 2
Form No. ITP-C-0001-10 INSPECTION FOR EXCAVATION RECORD REPORT

INSPECTION FOR EXCAVATION

RECORD REPORT

Structure : _____________________ Report No. : _____________________

Area/Unit : _____________________ Date : _____________________
Location : _____________________ Subcon : _____________________
: ASH Handling Facilities For Jawa 9&10
Project Reff.Dwg. : _____________________
CFSPP Project
Ref. : _____________________
Inspection Result
No Check Items Acceptance Criteria Remarks
Accept Reject
1 The work site is cleared
All grass and weeds including roots
2
are stripped and removed
Excavation is performed to the lines, As per approved
3
grades, and slopes as drawing drawings

Slope of all excavation are cut true As per the approved

4 and straight and loos stone and draings/field
boulders shall be removed in area inspection
Excavation is made below the
As per approved
5 elevation level indicates on the
drawings
design drawing
Excavation is kept free of water at
6 all times until complete of Field Inspection
construction or backfilling
Soil condition at the bottom of
7 Field Inspection
excavation
Protection work of excavated slope As per approved
8
area for safety JSA
Demolition or protection of As per approved
9
existing/nearest facility JSA
As per approved
Investigation of existing
10 drawings/as actual
underground faciliities
inspection at site
As per approved
Condition of compaction bottom
11 drawings/
surface
Specifications
Safety regarding excavation works, As per approved
12
confirmed JSA
As per actul
13 Quality of cleaning
Inspection
Result of compaction test after As per the test
14
excavation, confirmed (if necessary) reports
Note :

Submitted by Checked by Inspected by

IRT/OE
Sub-con Sign/Date Construction Sign/Date QC Inspector Sign/Date Sign/Date Sign/Date
(Rep.) (IRT)

Rev.1 12 of 13
 FIELD ITP FOR EARTH WORKS FOR ASH HANDLING FACILITIES
J910-DH02-P10ZEN-040001
APPENDIX 3
Form No. ITP-C-0001-11 INSPECTION FOR BACKFILL RECORD REPORT

INSPECTION FOR BACKFILL RECORD

REPORT

Structure : _____________________ Report No. : _____________________

Area/Unit : _____________________ Date : _____________________
Location : _____________________ Subcon : _____________________
: ASH Handling Facilities For Jawa 9&10
Project Reff.Dwg. : _____________________
CFSPP Project
Ref. Std. : _____________________
Inspection Result
No Check Items Acceptance Criteria Remarks
Accept Reject
Material for backfill are suitable and As per ITPs /
1
approved Specifications
No boulders and rock fragment are
2 As per actul Inspection
included
As per Visual and
3 The thickness per lay is adequated
survey reports
Adequated water sprayed when
4 As per test reports
compacting
Samples for field density test were
5 As per test reports
taken on test as per specification

Test result of field density are above

6 for fill or required by specification Verify by test reports
or contract dwgs

7 Recompact all faulted area and test As per test reports

Obtained max dry density according
8 As per test reports
to specification

9 Protection of slope safety As per approved JSA

Quality of cleaning before backfill As per visual
10
accepted inspection

Note :

Submitted by Checked by Inspected by

IRT/OE
Sub-con Sign/Date Construction Sign/Date QC Inspector Sign/Date Sign/Date Sign/Date
(Rep.) (IRT)

Rev.1 13 of 13