Form No : J910-DH02-P0SGE-048143

JAWA 9 & 10 CFSPP (2 X 1000 MW) Report No : 001/MIR/P-WS/09/22

PROJECT Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 1 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

QTY RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION DRAWING NO. REMARK
MTR BTG Rejected Accepted
PIPE ERW BLACK STEEL ASTM A53 Grade B SCH 40 Dia. 3 In
1 300000038969 82481B 84 14 JAW-WSD-GLM-G02A
SPINDO

2 300000039251 K70746 PIPE ERW BLACK STEEL ASTM A53 Grade B SCH 40 Dia. 4 In 54 9 JAW-WSD-GLM-G02A
SPINDO
PIPE ERW BLACK STEEL ASTM A53 Grade B SCH 40 Dia. 6 In
3 300000038851 K54862 90 15 JAW-WSD-GLM-G02A
SPINDO
PIPE ERW BLACK STEEL ASTM A53 Grade B SCH 40 Dia. 6 In
4 300000034409 2072085 6 1 JAW-WSD-GLM-G02A
SPINDO
PIPE ERW BLACK STEEL ASTM A53 Grade B SCH 40 Dia. 8 In
5 300000034134 K61351 6 1 JAW-IFC-LAY-002
SPINDO
PIPE SCH 80 SMLS ASTM A106 GR.B/A53 GR.B Dia. 1 1/2 In Ex
6 N200902131-000 3-36103 Japan / Eropa 396 66 JAW-WSD-GLM-G02A

7 281299 192651 PIPE SCH 80 SMLS ASTM A106 GR.B/A53 GR.B Dia. 1 In Ex 210 35 JAW-WSD-GLM-G02A
Japan / Eropa
PIPE SCH 80 SMLS ASTM A106 GR.B/A53 GR.B Dia. 2 In Ex
8 281302 820036 30 5 JAW-WSD-GLM-G02A
Japan / Eropa

9 BYYJ5325 J8KC845 PIPE SCH 80 SMLS ASTM A106 GR.B/A53 GR.B Dia. 3/4 In Ex 12 2 JAW-WSD-GLM-G02A
Japan / Eropa
Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : Name :
Date : 05 - 10 - 2022 Date : Date :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 2 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted
1 2628-04 12/70074 ELBOW 90 LR ASTM/A105N CLASS 3000 NPT Dia. 1 1/2 In Ex Japan / Eropa 129 Pcs JAW-WSD-GLM-G02A
2 20368-5880 16/79246 ELBOW 90 LR ASTM/A105N CLASS 3000 NPT Dia. 1 In Ex Japan / Eropa 84 Pcs JAW-WSD-GLM-G02A
3 152829/1-473 238142 ELBOW 90 LR ASTM/A105N CLASS 3000 NPT Dia. 2 In Ex Japan / Eropa 6 Pcs JAW-WSD-GLM-G02A
4 1224-497/12 11/39406 ELBOW 90 LR ASTM/A105N CLASS 3000 NPT Dia. 3/4 In Ex Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A
5 968674 58044094 ELBOW 90 LR ASTM/A234 WPB-S BW S40 Dia. 3 In Ex Japan / Eropa 20 Pcs JAW-WSD-GLM-G02A
6 9689005 69062106 ELBOW 90 LR ASTM/A234 WPB-S BW S40 Dia. 4 In Ex Japan / Eropa 7 Pcs JAW-WSD-GLM-G02A
7 967508 87004389 ELBOW 90 LR ASTM/A234 WPB-S BW S40 Dia. 6 In Ex Japan / Eropa 12 Pcs JAW-WSD-GLM-G02A
8 962652 93840577 ELBOW 90 LR ASTM/A234 WPB-S BW S40 Dia. 8 In Ex Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A
9 4223 94786908 ELBOW 90 LR ASTM/A234 WPB-S BW S40 Dia. 6 In Ex Japan / Eropa 6 Pcs JAW-WSD-GLM-G02A
10 212007 94789405 ELBOW 90 LR ASTM/A234 WPB-S BW S40 Dia. 3 In Ex Japan / Eropa 12 Pcs JAW-WSD-GLM-G02A
11 16948 94789406 ELBOW 90 LR ASTM/A234 WPB-S BW S40 Dia. 4 In Ex Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A
Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : Name :
Date : 05 - 10 - 2022 Date : Date :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 3 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted
TEE EQUAL ASTM/A105N CLASS 3000 NPT Dia. 1 1/2 In Ex Japan
17085 08/73277 / Eropa 36 Pcs JAW-WSD-GLM-G02A
1
TEE EQUAL ASTM/A105N CLASS 3000 NPT Dia. 3/4 In Ex Japan /
34607-4897 10/73410 Eropa 2 Pcs JAW-WSD-GLM-G02A
2
0029 CF760 TEE EQUAL ASTM/A234 WPB-S BW S40 Dia. 3 In Ex Japan / Eropa 2 Pcs JAW-WSD-GLM-G02A
3
0031 BS682 TEE EQUAL ASTM/A234 WPB-S BW S40 Dia. 6 In Ex Japan / Eropa 2 Pcs JAW-WSD-GLM-G02A
4
0032 CD276 TEE EQUAL ASTM/A234 WPB-S BW S40 Dia. 8 In Ex Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A
5
TEE RED ASTM/A105N CLASS 3000 NPT Dia. 1 1/2 x 3/4 In Ex
26299-219 11/77569 30 Pcs JAW-WSD-GLM-G02A
6 Japan / Eropa
TEE RED ASTM/A105N CLASS 3000 NPT Dia. 1 1/2 x 3/4 In Ex
9257-91 09/78199 130 Pcs JAW-WSD-GLM-G02A
7 Japan / Eropa

8630-109 09/77959 TEE RED ASTM/A105N CLASS 3000 NPT Dia. 2 x 1 1/2 In Ex 4 Pcs JAW-WSD-GLM-G02A
8 Japan / Eropa

4701-123 08/76528 TEE RED ASTM/A105N CLASS 3000 NPT Dia. 2 x1 In Ex Japan / 1 Pcs JAW-WSD-GLM-G02A
9 Eropa

99 J8K8106 TEE RED SA/A234 WPB-S BW S 40 Dia. 4 x 3 In Ex Japan / Eropa 2 Pcs JAW-WSD-GLM-G02A
10
34 7-34642 TEE RED SA/A234 WPB-S BW S 40 Dia. 6 x 3 In Ex Japan / Eropa 4 Pcs JAW-WSD-GLM-G02A
11
0039 BV266 TEE RED SA/A234 WPB-S BW S 40 Dia. 8 x 6 In Ex Japan / Eropa 2 Pcs JAW-WSD-GLM-G02A
12
TEE RED SA/A234 WPB-S BW S 40 Dia. 3 x 2 1/2 In Ex Japan /
967232 52880343 MT 8 Pcs JAW-WSD-GLM-G02A
13 Eropa

38 BY599 TEE RED SA/A234 WPB-S BW S 40 Dia. 8 x 4 In Ex Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A
14
TEE RED ASTM/A105N CLASS 3000 NPT Dia. 1 x 3/4 In Ex Japan /
5176 08/71602 1 Pcs JAW-WSD-GLM-G02A
15 Eropa

28526 RED. TEE 1 1/2 x 3/4 3000 NPT A105N 160 Pcs JAW-WSD-GLM-G02A
16
Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : Name :
Date : 05 - 10 - 2022 Date : Date :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF PIPING Area : CCB area Page Of. : 4 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted
BUSHING / VLOG RING ASTM/A105N CLASS 3000 NPT Dia. 1 x 3/4 In Ex Japan
1 AD4752 / Eropa 76 Pcs JAW-WSD-GLM-G02A

BUSHING / VLOG RING ASTM/A105N CLASS 3000 NPT Dia. 2 x 1 1/2 In Ex

2 7917 08/71876 Japan / Eropa 3 Pcs JAW-WSD-GLM-G02A

3
4
5
6
7
8
9
10
11
12
12
13
14
15
16
Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : Name :
Date : 05 - 10 - 2022 Date : Date :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 5 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted
1 194663 94784678 CON RED SA/A234 WPB-S BW S 40 Dia. 3 x 1 1/2 In Ex Japan / Eropa 8 Pcs JAW-WSD-GLM-G02A
2 0048 AZ932C CON RED SA/A234 WPB-S BW S 40 Dia. 3 x 2 In Ex Japan / Eropa 2 Pcs JAW-WSD-GLM-G02A
3 0048 BD188D CON RED SA/A234 WPB-S BW S 40 Dia. 3 x 2 In Ex Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A
4 0050 BA249D CON RED SA/A234 WPB-S BW S 40 Dia. 4 x 3 In Ex Japan / Eropa 5 Pcs JAW-WSD-GLM-G02A
5 0052 AZ124C CON RED SA/A234 WPB-S BW S 40 Dia. 6 x 4 In Ex Japan / Eropa 6 Pcs JAW-WSD-GLM-G02A

Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : Name :
Date : 05 - 10 - 2022 Date : Date :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 6 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted

1 039603 AS4011 END PLUG ASTM/A105N CLASS 3000 NPT Dia. 3/4 In Ex 55 Pcs JAW-WSD-GLM-G02A
Japan / Eropa

Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : Name :
Date : 05 - 10 - 2022 Date : Date :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 7 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted

1 12 17304631 BLIND FLANGE ANSI ASME B 16.5 FORGED FLANGE CLASS 150 Dia 3 3 Pcs JAW-WSD-GLM-G02A
Inch Ex Japan / Eropa
FLANGE SO RF ANSI ASME B 16.5 FORGED FLANGE CLASS 150 FF Dia 1
2 4 17304631 8 Pcs JAW-WSD-GLM-G02A
1/2 Inch Ex Japan / Eropa

3 6 17304631 FLANGE SO RF ANSI ASME B 16.5 FORGED FLANGE CLASS 150 FF Dia 2 8 Pcs JAW-WSD-GLM-G02A
1/2 Inch Ex Japan / Eropa
FLANGE SORF ANSI ASME B 16.5 FORGED FLANGE CLASS 150 FF Dia 3
4 0050 A082580-01 Inch Ex Japan / Eropa 3 Pcs JAW-WSD-GLM-G02A

FLANGE SORF ANSI ASME B 16.5 FORGED FLANGE CLASS 150 FF Dia 6
0070 A0854A1-AD 8 Pcs JAW-WSD-GLM-G02A
5 Inch Ex Japan / Eropa

6 008 21111656 SLIP ON FLANGE ANSI ASME B 16.5 FORGED FLANGE CLASS 150 RF Dia 1 Pcs JAW-WSD-GLM-G02A
8 Inch Ex Japan / Eropa
BLIND FLANGE ANSI ASME B 16.5 FORGED FLANGE CLASS 150 Dia 8
0060 A664 1 Pcs JAW-WSD-GLM-G02A
7 Inch Ex Japan / Eropa
8
9
10
Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : :
Date : 05 - 10 - 2022 Date : :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 8 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted

1 01 S 051 RED COUPLING ASTM/A105N CLASS 3000 NPT Dia. 1 1/2 x1 In Ex 73 Pcs JAW-WSD-GLM-G02A
Japan / Eropa
RED COUPLING ASTM/A105N CLASS 3000 NPT Dia. 2 x 3/4 In Ex Japan /
2 01 S 316 1 Pcs JAW-WSD-GLM-G02A
Eropa

3 01 S 316 RED COUPLING ASTM/A105N CLASS 3000 NPT Dia. 2 x 1 1/2 In Ex Japan 1 Pcs JAW-WSD-GLM-G02A
/ Eropa

4 18727 15/74827 COUPLINGS ASTM SA/A105N CLASS 3000 NPT Dia. 2 In Ex Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A

7
8
9
10
Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : :
Date : 05 - 10 - 2022 Date : :
Signature : Signature : Signature :
 Form No : J910-DH02-P0SGE-048143
JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Report No : 001/MIR/P-WS/09/22
Date : 30-09-22 PO Number :
Subject : MATERIAL INSPECTION REPORT OF FIRE HYDRANT, SPRINKLER & WATER BASED SYSTEM Area : CCB area Page Of. : 9 of 9
Location : Suralaya, Jawa Unit 9 & 10 ITP No. : J910-QM01-P0SGE-045047 Rev. No :0
EPC : PT. Hutama Karya Autorized by. Joseph K Triyoga Name Of Activity :
Subcont : PT. Indobara Bahana
Receiving Material Piping On CCB Area

RESULT
NO ITEM CODE HEAT NO. ITEM DESCRIPTION QTY UNIT DRAWING NO. REMARK
Rejected Accepted

1 3 S 316 THREADOUTLET ASTM/A105N CLASS 3000 NPT Dia. 1 1/2 In Ex Japan / 30 Pcs JAW-WSD-GLM-G02A
Eropa
THREADOUTLET ASTM/A105N CLASS 3000 NPT Dia. 1 In Ex Japan /
2 4 S 539 5 Pcs JAW-WSD-GLM-G02A
Eropa

3 2 S 646 THREADOUTLET ASTM/A105N CLASS 3000 NPT Dia. 2 In Ex Japan / 1 Pcs JAW-WSD-GLM-G02A
Eropa
UNION / WATERMOUR ASTM/A105N CLASS 3000 NPT Dia. 3/4 In Ex
4 5689-10109 06/74668 Japan / Eropa 1 Pcs JAW-WSD-GLM-G02A

UNION / WATERMOUR ASTM/A105N CLASS 3000 NPT Dia. 1 In Ex

26882-234/15 12/72672 1 Pcs JAW-WSD-GLM-G02A
5 Japan / Eropa
6
7
8
9
10
Noted :

Prepared by : IBB Checked by : IRT / OE

Name : M ARINALHAQ E N Name : :
Date : 05 - 10 - 2022 Date : :
Signature : Signature : Signature :
 Report No. :

JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Date :

Area : Page of :

Subject : Material Inspection Report of Piping

Location : ITP No. : Rev. No. : 0

EPC :

Subcont : Receiving Material Piping on

Result
No. Matcode Brand/Orign Description Size Qty. UOM Heat No. Remarks
Rejected Accepted
1 PAAZZBOZZABAABSAAZZUS BENTELER/GERMANY PIPE, ASTM A106-B, SMLS, BE, ASME-B36.10M, S-40 125 mm 54 MTR 589687 - √

Noted :

Prepared by : Checked by : HK - QC IRT/OE

Name : Name : Name :

Date : Date : Date :

Signature : Signature : Signature :
 Report No. :

JAWA 9 & 10 CFSPP (2 X 1000 MW) PROJECT Date :

Area : Page of :

Subject : Material Inspection Report of Piping

Location : ITP No. : Rev. No. : 0

EPC :

Subcont : Receiving Material Piping on

Signature : Signature : Signature :

Result
No. Matcode Brand/Orign Description Size Qty. UOM Heat No. Remarks
Rejected Accepted