REPORT OF

INSPECTION AND TESTING

STAND

MEREK / TYPE : MUDA KREATIF / FIXED

NO SERI / NO UNIT : SJ015-0009
CAPACITY / SWL : 15 TON

PT SAPTAINDRA SEJATI
JOB SITE PT MARUWAI COAL
PURUK CAHU - KALIMANTAN TENGAH
INSPECTION CERTIFICATE

Certificate Number :
0889/CER-STAND/JKTI-SIS-MK-AMC/IX/2023

The periodic inspection has been conducted to :

Owner : PT Saptaindra Sejati
Location : Job Site PT Maruwai Coal
Equipment : Stand
Dimension (mm) : Dia Pipe : 5'', H : 520 mm
Manufacture : PT Muda Kreatif
Type Stand : Fixed
Year of Manufacture : 2023
Number of Id : SJ015-0009
Capacity / WLL (Ton) : 15
Colour Code : -

Inspection Result :
Feasible to Use

Reference inspection as per procedure :

Minister of Manpower Regulation Republic Indonesia : No. 8 2020 About Lifting Inspection
ASME PASE-2014 (Safety Standard for Portable Automotive Service Equipment)

Inspection Date Expiration Date

September 4, 2023 September 4, 2024

Issued Date :
September 4, 2023

Lisa E. Gunawan. SE.MT

Director
 PERIODIC INSPECTION REPORT
STAND

Form Report No./02-08-01JKTI/ABA/Stand/ REV 0

Report No. 0889/CER-STAND/JKTI-SIS-MK-AMC/IX/2023 Page 1/2

Owner PT Saptaindra Sejati WLL (Tonne) 15

Location Job Site PT Maruwai Coal Load Test (Tonne) -
Number of Id SJ015-0009 Type Fixed
Manufacture PT Muda Kreatif Colour Code -
Year of Manufacture 2023 Date of Inspection September 4, 2023
Dimension (mm) Dia Pipe : 5'', H : 520 mm Next Inspection Date September 4, 2024
STAND INSPECTION RECORD
Condition
No. Component Checked Remarks / Picture
Accepted Rejected
Corrosion ✓ - ACC During Inspection
Deformation ✓ - ACC During Inspection
1 Main Frame Deflection ✓ - ACC During Inspection
Crack ✓ - ACC During Inspection
Bolt And Nuts ✓ - ACC During Inspection
Corrosion ✓ - ACC During Inspection
Deformation ✓ - ACC During Inspection
2 Top Plate
Crack ✓ - ACC During Inspection
Welded ✓ - ACC During Inspection
Corrosion ✓ - ACC During Inspection
Deformation ✓ - ACC During Inspection
3 Base Plate
Crack ✓ - ACC During Inspection
Welded ✓ - ACC During Inspection
Corrosion - - N/A
Deformation - - N/A
Adjustable
4 Bolt And Nuts - - N/A
Mechanism
Welded - - N/A
Gear - - N/A
Corrosion - - N/A
Deformation - - N/A
5 Adjustable Hydraulic Bolt And Nuts - - N/A
Welded - - N/A
Leakage - - N/A
Corrosion - - ACC During Inspection
Deformation - - ACC During Inspection
6 Pad Eye
Crack - - ACC During Inspection
Welded - - ACC During Inspection
Damaged ✓ - ACC During Inspection
7 Name Plate
Missing ✓ - ACC During Inspection

Other conditions,
including visible
8 Other damage body, that ✓ - ACC During Inspection
cause doubt as to the
continued use body
 PERIODIC INSPECTION REPORT
STAND

Form Report No./02-08-01JKTI/ABA/Stand/ REV 0

Report No. 0889/CER-STAND/JKTI-SIS-MK-AMC/IX/2023 Page 2/2

Customer PT Saptaindra Sejati WLL (Tonne) 15

Location Job Site PT Maruwai Coal Load Test (Tonne) -
Number of Id SJ015-0009 Type Fixed
Manufacture PT Muda Kreatif Colour Code -
Year of Manufacture 2023 Date of Inspection September 4, 2023
Dimension (mm) Dia Pipe : 5'', H : 520 mm Next Inspection Date September 4, 2024
STAND INSPECTION RECORD
Proof Load Test
Load Test (Ton) Holding Time (minutes) Result

- - -
Refrence Inspection as per procedure :
Permenaker 8 2020
Remarks / Recommendetion : All Result
Not defective and damaged on structure stand Stand safe to use
Reviewed / Witnessed by : Autorized Inspector
PT Janji Karya Tehnik Inspeksi

Yusuf Kholis Subhana

Date : Date : September 4, 2023
 NON DESTRUCTIVE TEST
MAGNETIC PARTICLE

Form Report No.02/NDT-MT/JKTI/2020 REV 00

Report No. 0889/CER-STAND/JKTI-SIS-MK-AMC/IX/2023 Page 3/3

Customer PT Saptaindra Sejati WLL (Tonne) 15

Location Job Site PT Maruwai Coal Load Test (Tonne) -
Number of Id SJ015-0009 Type Fixed
Manufacture PT Muda Kreatif Colour Code -
Year of Manufacture 2023 Date of Inspection September 4, 2023
Dimension (mm) Dia Pipe : 5'', H : 520 mm Next Inspection Date September 4, 2024
Procedure Number : JKTI-MSS/02/MAGNETIC White Contrast : WCP 2
Brands Name /
Material Spec : Forged Steel Magnaflux Cleaner : SKC - S
Type
Magnetic Methode : Yoke Permanent MPI Ink : 7hf
Magnetic Material : Visible Light Intensity : 1300 Lux
Surface Conditiaon : As Forged ; Time Of Examination : After Visual Check ; Scope of Examinantion : Base Forged
Result Type
Part Name Ø / Thickness Remarks
Accepted Rejected Discontinuities
Welding Joint - ✓ - - ACC During
Inspection

Picture :

Reviewed / Witnessed by : NDT MT/PT Level II

PT Janji Karya Tehnik Inspeksi

Yusuf Kholis Subhana

Date : Date : September 4, 2023
 DOCUMENTATION

Form Report No.02/NDT-MT/JKTI/2020 REV 00

Report No. 0889/CER-STAND/JKTI-SIS-MK-AMC/IX/2023 Page 4/4

VISUAL STAND
ATTACHMENT