PSIR - Gas Bottle Rack - BSL 16695 - LNG 015

PRE-SHIPMENT INSPECTION REPORT OF
LIFTING EQUIPMENT
This report complies with Lifting Operations and Lifting Equipment Regulations 1998 (SI 2301)
Date of report: February 29th, 2024 Report Number: PSIR.076.LG125.L2.II.2024
Contract No: 4420003008 RFI Number: 3596.LE.L2.II.2024

Contractor/Supplier/ Naku Freight Indonesia, (PT. Kuehne Nagel Inspection Location: PT. TD Energy Services Workshop -
Vendor: Indonesia) Kelapa Gading
Project: QUALITY ASSURANCE & INSPECTION
SERVICES FOR MATERIALS, HEAVY
EQUIPMENT & PACKAGE TOOLS
Date of Inspection: February 28th, 2024
Description and identification number of item(s) including date of manufacture (if known) Safe working load(s) for last Date of last thorough
configuration it was examination:
thoroughly examined:
1. Gas Bottle Rack - Identification No. BSL 16695, 1 Ea. complete with lifting set February 16th, 2024
Payload
Manufacture : Dalian CIMC Logistics Equipment Co., Ltd. RPT/SPT/JKT/2024/II/3457B-
N/K Year Manufactured : October 2012 4/014 - Rev1
2500 Kg
Serial No. / Tag No. : H001456 / BSL 16695 ( refer Cert. Lloyd Register Offshore Container Construction SHI1483324·05)
By PT. Siaptek
Dimension : 1270 mm (L) x 1150 mm (W) x 2285 mm (H)
Tare Mass : 700 Kg
Maximum Gross Weight : 2500Kg
Payload : 1800 Kg
4 Leg Wire rope sling - Identification No. 14/0887/2, 14/0887/3, M/19/0876/2 & WAL/13/3710/4, 1 Ea.
Manufacture : PT. Wiguna Artha Lestari (WAL)
Working Load Limit (WLL)
N/K Year Manufactured : October 18th, 2013 & August 28,2023
Serial No. / Tag No. : 14/0887/2, 14/0887/3, M/19/0876/2 & WAL/13/3710/4
11.30 tonne (0-25⁰ Angle)
Construction Wire Rope : GALV. 6 x 36 WS+IWRC RHRL mm (refer Cert. Offshore Container Lifting Slings No. 020626 & MPJ/C/19/0876)
Diameter & Length Wire Rope : 18 mm and 1700 (L) mm
Color Code : (Periode December 2023 to July 2024) GREEN
Shackle - Identification No. WAL/14/1491 up to WAL/14/1494
Manufacture : The Crosby Group
Working Load Limit (WLL)
N/K Year Manufactured : April 04th, 2014
Serial No. / Tag No. : WAL/14/1491 up to WAL/14/1494
4.75 tonne
Type of Shackle : G.2130 Bolt Type Anchor Shackle
(refer The Crosby Group Certificate No. CC1-2014040400933)
Color Code : (Periode December 2023 to July 2024) GREEN
Note: Photographic Report is attached.
Is this the first examination after or after installation assembly at a new site or Was the examination carried out :
location? 1. Within an interval of 6 months? YES √ NO
If the answer to the above question is YES, YES NO √ 2. Within an interval of 12 months? YES NO √
3. In accordance with an examination scheme? YES √ NO

Has the equipment been installed correctly YES √ NO 4. After the occurrence of exceptional: YES NO √
and would be safe to operate?
5. Months between examination (if known):
Particulars of any repair, renewal or alteration required to remedy the defect identified above: (If none state NONE)
None
Particulars of any tests carried out as part of the examination: (If none state NONE)
None Cross Referenced Report Number:
Is the above a defect which is of immediate danger to persons? YES NO √
Is the above a defect which is not yet but could become a danger to persons? (If YES state the date by
YES by: dd-mm-yy NO √
when)
Acceptance criteria: *Thick the box "√" if appropriate. *
1. APC-000-PRC-OP-20002 - AsPac Management of Lifting Operations and Lifting Equipment √
2. BP Procedure 100572 "Management of Lifting Operations and Lifting Equipment" √
3. BS EN 12079-3:2006 "Offshore Container and associated lifting sets part 3: Periodic Inspection, Examination and Testing" √
4. DNV 2.7-1 : 2006 "Standard for Certification Offshore Container" √
5. DNV 2.7-2 : 2013 "Standard for Certification Offshore Services Module" √
6. DNV 2.7-3 : 2011 "Standard for Certification Portable Offshore Unit" √
7. EN ISO 13414-1 : 2003 "Steel wire rope slings. Safety. Slings for general lifting service" √
8. EN ISO 13414-2 : 2003 "Steel wire rope slings. Safety. Specification for information for use and maintenance to be provided by the manufacturer" √
9. EN ISO 13889 : 2003 "Forged steel shackles for general lifting purposes. Dee shackles and bow shackles grade 6 fafety" √
Inspection result: IS THIS EQUIPMENT SAFE TO USE? YES √ NO

Recommendation: Latest date by which next thorough examination must be carried out dd-mm-yy
I hereby that this report is not for certification but as advises support and on the date(s) mentioned above, the items described in this report were thoroughly examined so far as was accessible and the
particulars given are correct.
Name of the person making this report: signature:
Pradhipta Winahyu Nurobbi
Qualifications:
LEEA Part 1, LEEA Part 2, CI, WI
Company & Address:
Consortium
PT. Depriwangga & TUV SUD Indonesia
DW Building, Jl. Cisanggiri 1 No. 8, Kebayoran Baru
–Jakarta Selatan 12170
Tel: 021 7209304 | Fax: 021 7209406
Page 1 of 3
Form No.: LF-003-PSIR
LIFTING EQUIPMENT

Contractor/Supplier/ Naku Freight Indonesia, (PT. Work Location: PT. TD Energy Services Workshop
Vendor: Kuehne Nagel Indonesia) - Kelapa Gading
QUALITY ASSURANCE &

INSPECTION
Project: SERVICES FOR MATERIALS,
HEAVY
PHOTOGRAPHIC REPORT
Fig. 1 Description of Gas Bottle Rack Fig. 2 Maximum Gross Weight (MGW) 2500 Kg Fig. 3 Manufacturer Inspection Data Plate
(Identification No. BSL 16695) (Identification No. BSL 16695) (Identification No. BSL 16695)
Fig. 4 Third Party Inspection Data Plate Fig. 5 Data plate of wire rope sling lifting set Fig. 6 Latest inspection date wire rope sling lifting
(Identification No. BSL 16695) (Identification No. BSL 16695) (Identification No. BSL 16695)
Fig. 7 4 Leg wire rope sling - Leg 1 Fig. 8 4 Leg wire rope sling - Leg 2 Fig. 9 4 Leg wire rope sling - Leg 3
(Identification No. 14/0887/1) (Identification No. M/19/0876/2) (Identification No. 14/0887/3)
Page 2 of 4
Form No.: LF-004-PSIPR

LIFTING EQUIPMENT

Contractor-Supplier- Naku Freight Indonesia, (PT. Work Location: PT. TD Energy Services Workshop
QUALITY ASSURANCE &

INSPECTION
HEAVY
PHOTOGRAPHIC REPORT
Fig. 10 4 Leg wire rope sling - Leg 4 Fig. 11 Shackle lifting set - Shackle 1 Fig. 12 Shackle lifting set - Shackle 2
(Identification No.14/0887/4) (Identification No. WAL/13/6560 ) (Identification No. WAL/13/6561)
Fig. 13 Shackle lifting set - Shackle 3 Fig. 14 Shackle lifting set - Shackle 4 Fig. 15 Front Side Condition Gas Bottle Rack
(Identification No. WAL/13/6562) (Identification No. WAL/13/6563) (Identification No. BSL 16695)
Fig. 16 Side Condition Gas Bottle Rack Fig. 17 Marking of Color Code GREEN Fig. 18 Lifting Sets Color Code GREEN (Identification
(Identification No. BSL 16695) (Identification No. BSL 16695) No. BSL 16695)
Page 3 of 4

LIFTING EQUIPMENT

Contractor-Supplier- Naku Freight Indonesia, (PT. Work Location: PT. TD Energy Services Workshop
QUALITY ASSURANCE &

INSPECTION
HEAVY
PHOTOGRAPHIC REPORT
Fig. 19. Top Side Condition Gas Bottle Rack Fig. 20 Pad Eyes/Lifting Point Condition Fig. 21 Additional Marking identification LNG 011
(Identification No. BSL 16695) (Identification No. BSL 16695) Condition (Identification No. BSL 16695)
Page 4 of 4

LIFTING INSPECTION CHECKLIST
FOR
OFFSHORE CONTAINER / CCU
New Rental
Contractor: Naku Freight Indonesia, (PT. Kuehne Nagel Indonesia) Inspection Checklist No.: PSIR.076.LG125.L2.II.2024
Location of Inspection: PT. TD Energy Services Workshop - Kelapa Gading Date of Inspection: February 28th, 2024
Offshore Container Serial No.: H001456 / BSL 16695
Offshore Container Type: Gas Bottle Rack Offshore Container
Conformance Status
Satisfactory
Comment
Item No. Description Remarks
Photos
Safety
C NC
A. Certification Information
Issued by Lloyd Register refer Cert.
A1 Certificate for Offshore Container (Certificate of Conformity) √ √ Offshore Container Construction No.
SHI1483324·05
Issued by PT. Wiguna Artha Lestari
(WAL) refer Cert. Offshore Container
A2 Certificate for Offshore Container Lifting Slings (Certificate of Conformity) √ √ Lifting Slings No. 020626 & PT.
Mitra Pradana Jaya Cert. No.
MPJ/C/19/0876
Issued by Kiswire refer Cert. No 2012-
04-013 /RW11163, USHA Martin
Report. No. E-A065420003,, The
Certificate for Lifting Set Components
A3 √ √ Crosby Group Masterlink Cert No.
(Certificate of Conformity) CC1-2014040500001
, The Crosby Group Cert. No. CC1-
2014040400933)
A4 Valid Offshore Container Report of thorough examination (12 monthly) √ √ -
Issued By PT. Siaptek

A5 Valid Lifting Set Report of thorough examination (6 monthly) √ √ "RPT/SPT/JKT/2024/II/3457B-4/014 -
Rev1 February 16th, 2024"
Issued By PT. Siaptek

A6 Valid Pad eyes Report of NDE √ √ "RPT/SPT/JKT/2024/II/3457B-4/014A
- Rev1 February 16th, 2024"
A7 Valid Offshore Container Report of Lifting Test √ √ -
A8 Valid Offshore Container Report of Vertical Impact Test (if applicable) - -
A9 Other Tests (please specify) - -
B. Markings Information
B1 Safety Marking √ √
B2 Identification and Certification Markings √ √
B3 Information Markings √ √
B4 Marking of Lifting Set √ √
B5 Marking on Data Plate √ √
B6 Marking on Inspection Plate √ √
B7 Other Marking (Should be kept to a minimum) - - N/A
C. Visual Examination
C1 Pad eyes (Lifting Points) √ √
C2 Top side rail √ √
C3 Top end rail √ √
C4 Corner post √ √
C5 Bottom side rail √ √
C6 Bottom end rail √ √
C7 Intermediate cargo decks (if any) - - N/A
C8 Stacking fittings (if any) - - N/A
C9 ISO-corner fittings - - N/A
C10 Floor (Wooden floor is not allowed) √ √
C11 Fork lift pockets √ √
C12 Container walls √ √
C13 Roof plate √ √
C14 Door √ √
C15 Door hinges √ √
C16 Door locking devices √ √
C17 Door gaskets or seals - -
C18 Internal securing points (Hinged lashing points are recommended) √ √
C19 Tugger points - -
C20 Equipment (if any) √ √
C21 Drainage facility (if applicable) √ √
C22 Coating and corrosion protection √ √
C23 Steel Wire Rope Slings c/w fittings √ √
C24 Shackles (c/w safety pin) √ √
C25 Master links and assembly √ √
C26 Color code of Offshore Container and Lifting set √ √ GREEN
D. Dimensional Conformance
D1 Pad eyes (Thickness, hole diameter, etc.) √ √
D2 Steel Wire Rope Slings √ √
D3 Shackles √ √
E. Conformity
Is this Offshore Container conforming to Standard?* C: Conformance NC: Non Conformance

*Thick one box "√" if appropriate.
Remarks
Inspector Name: Pradhipta Winahyu Nurobbi
Qualification: LEEA Part 1, LEEA Part 2, CI, WI
Signature:
Form No.: BP-ICL-OP-02-A Rev. 1
Client Certification Package
BSL16695 (Gas Bottle Rack)
Section 1: Approval Certificates

Section 2 : Lifting Set Certificates
Section 3 : Lifting Set COC
Section 4 : Shackle Set COC
Section 5 : 3rd Party NDT Report
Section 6 : Inspector Certificates
PT TD ENERGY SERVICES
Heartline Center Building 5th Floor,
Jl. Permatasari No. 1000, Villa Permata – Lippo Karawaci Tangerang 15810
Phone : 6221-5565 8270 Fax : 6221 5565 7271
Mail: sales@tdenergyservices.com Web: www.tdenergyservices.com

Section 1:
Approval Certificates
Phone : 6221-5565 8270 Fax : 6221 5565 7271

CERTIFIED COPY
Certificate no: SHI1483324-05
Page 1 of 1
Offshore Container Construction Certificate

(With Enhancement Factor)
Name of Manufacturer Address:
Dalian CIMC Logistics Equipment Co., Ltd. Ill B-2, Free Trade Zone, Dalian, liaoning, China
This is to certify that theu;:;-cier:-rmtedOffshore-Cont ainer, ~hich ;;as· man ufactured a-;;-d· testedlrl acc;rdanc~ ~iththe requirements of Lloyd's Register
Group Container Certification Scheme, has been inspected and fou nd to be in accordance with the approved drawings and the prototype container
identified as follows:
Offshore Container Type Description Number of Lifting Lugs:
Gas Bottle Rack Container 4
Max. Gross Mass (Rating): Tare Mass: Payload:
2500 kg 700 kg 1800 kg
External Di mensions (LxWxH): Design Temperature:
1270 mm 1150 mm 2285 mm -40°C
Lloyd's Register Group Type Approval No.: Assembly Drawing No.:
GB-LR 22192-09/2012 PLT-560-G
Purchaser
BSL CONTAINERS LIMITED
Container Model No.: Manufacturer's Serial No I Owners No: Date of M anufacture I Inspection Type:
OBR 004 H001456/BSL16695 MARCH 2014
Specification of lifting set. This certificate is on ly valid w hen the container is fitted w ith approved lifting set.
Min. shackle bolt diameter: Max. angle of legs (from vertical): Enhancement factor
22mm 45° 2.880
Proof testing:
This offshore container, or another offshore container from the same fab rication series, has been subjected to the fo llowing proof test:
Man ufactu rer's Serial No. of container tested : Total test load (2.5R): Test date:
H001452 6250 kg 2014.2.27
The container also complies with the following requirements and regulations:
EN12079-1:2006 & DNV2.7-1:2013 in support of IMO MSC/Circ. 860(1998).
Remarks:
Issued at SHANGHAI on MARCH 17, 2014

...---~--- --------.
Lloyd's Rcgist::::r Cl:scificntion _
'.'~.c~~ty(2ili~.::) ~
Co . ,UJ. ,
1 u1HIS:I3 \.:•·-· I l loyds
I~" :nn'ni 0\tico 'egl'·ter
_. --- ---
HENRY HUAN FOR TIGER Ll AND SELF
Inspector to Lloyd's Register Classif ication Society (C hina) Co., Ltd.
A member of the Lloyd's Register Group
Lloyd's Register Group Limited, its affiliates and subsidiaries and t heir respective officers, employees or agents are, individually and collectively, referred to in t his clause as
'Lloyd's Register'. Lloyd's Register assumes no responsibility and shall not be liable to any person for any loss, damage or expense caused by reliance on the infor mat ion or
advice in this document or howsoever provided, unless that person has signed a contract with the relevant Lloyd's Register ent ity for the provision of this information or
advice and in that case any responsibi lity or liability is exclusively on the terms and conditions set out in that contract.
Form 5216F (2014.01)

Section 2:
Lifting Set Certificates
Phone : 6221-5565 8270 Fax : 6221 5565 7271

Section 3:
Lifting Set COC
Phone : 6221-5565 8270 Fax : 6221 5565 7271

,._
I61SWire
INVOICE NO. 2012 - 04 - 013 I RW11163 DATE 23. Apr, 2012
MILL TEST CERTIFICATE

THiS IS TO CERTIFY THAT THE MATERIAL DESCRIBED BELOW WAS MANUFACTURED
IN ACCORDANCE WITH KISWIRE SPECIFICATION AND APPLICABLE SECTIONS
OF BS EN 12385-4:2002 ( 1960 N/mm©+ )
TO MESSRS PT WIGUNA ARTHA LESTARI
MATERIAL DESCRIPTION DRAWN GALVANIZED STEEL WIRE ROPE
06 X 36(WS) + IWRC 1,440.00 M X 2 REEL
TYPE
EX NO. RW11163-1
6-7 SAMPLING NO. 6
DIAMETER OF ROPE
TYPE OF CORE
BREAKING STRENGTH 226.00 kN SAMPLE BROKE AT 249.34 kN
WT OF ZINC COATING OF OUTER WIRE MIN. 85.000
ROPE LAY RHRL LAY LENGTH 115.30 mm
LUBRICATION A-3
CHEMICAL ANALYSIS OF WIRE ROD

CHARGE NO. ex 100 SiX 100 MnX 100 PX 1000 S X 1000
SBA1176811
DATE OF SAMPLE TEST
KISWIRE
COMPANY WITH
QUALITY SYSTEM
CERTIFIED BY DNV
= ISO 9001 :2008 =
thellrasbyiraup
2801 Dawson Rd
Tulsa, OK 74110
www.thecrosbygroup.com
Certificate of Conformance
Certificate Number: CC1-2014040500001
Location of Issue: PT Wiguna Artha Lestari
Rukan Citta Graha 2-I, JL Panjang Arteri Kedoya No. 26
Jakarta, 11520 Indonesia
Phone: 62 215 816996 Fax: 62 215-816677
Stock No: 1258142

Description of Gear: A34 7 1-1/8" Welded Master Link Assembly
IWorking Load Limit: 31,900 lbs I IMax. Allowed Proof Load: 79,800 lbs I
Comments: Ultimate load is 5 times the WLL
Note: Meets or exceeds all requirements of ASME B30.26. Proof tested according to
and with fixture sized to prevent localized point loading per ASTM A952.
Has not been contaminated by Mercury or Asbestos in the manufacturing process.
Number of Pieces: 1 Main Link: 1MU Distributor Note: W AL/C/14/0887
PICs are based on visual observation
Certificate based on item being the Crosby product described above.
We hereby certify that the above described material was manufactured and processed in a manner compatible to
meeting the load ratings when used under normal and proper applications.
Mentioned products are in conformity to the Crosby literature available at time of manufacturing, including the
following trademarked features:
(€
All Crosby plants are ISO 9001 :2008 certified for quality and consistency of the processes.
For Product Delivered To: PT. TD Energy Services

Hemtline Center Building 5th, Fl.
Jl. Permatasari 1000 Villa Permata , Lippo Karawaci
Lippo Karawaci Indonesia
Customer (User) Order Number: TD/076/0L-P0/04/14/WAL
April 05, 2014

Date: Signature:
Date of Issuance Don Conner, Crosby Quality Assw-ance Manager
Section 4:
Shackle Set COC
Phone : 6221-5565 8270 Fax : 6221 5565 7271

COMPANY WITH
QUALITY SYSTEM
CERTIFIED BY DNV
= ISO 9001 :2008 =
theiPasbgDraup
2801 Dawson Rd
Tulsa, OK 74110
www.thecrosbygroup.com
Certificate of Conformance
Certificate Number: CC1-2014040400933
Location of Issue: PT Wiguna Artha Lestari
Rukan Citta Graha 2-I, JL Panjang Arteri Kedoya No. 26
Jakarta, 11520 Indonesia
Phone: 62 215 816996 Fax: 62 215-816677
Stock No: 1019515

Description of Gear: G2130 4-3/4t Bolt Type Anchor Shackle 3/4" Maxtough®
IWorking Load Limit: 4-3/4t I IMax. Allowed Proof Load: 9-l/2t I t indicates metric tons
Comments: Minimum ultimate strength is 6 times the WLL
Note: Meets the performance requirements of Federal Specification RR-C-271F Type IVA,
Grade A, Class 3, except for those provisions required of the contractor.
Meets or exceeds all requirements of ASME B30.26.
Has not been contaminated by Mercury or Asbestos in the manufacturing process.
Number of Pieces: 4 Bow: 5NO Distributor Note: WAL/C/14/0887- 14/1491-1494
PICs are based on visual observation
Certificate based on item being the Crosby product described above.
We hereby certify that the above described material was manufactured and processed in a manner compatible to
meeting the load ratings when used under normal and proper applications.
Mentioned products are in confonnity to the Crosby literature available at time of manufacturing, including the
following trademarked features:
n"'-,Jl ~~ M uA 1fil'"ftl ~®
CE
~ ~
O.A1...1·
~teQIIIRt w·
QUIC-CHECK"
IYIIMIIII ~ ~!!!-
All Crosby plants are ISO 9001:2008 certified for quality and consistency of the processes.
For Product Delivered To: PT. TD Energy Services

Heartline Center Building 5th, Fl.
Jl. Permatasrui 1000 Villa Permata , Lippo Karawaci
Lippo Kru·awaci Indonesia
Customer (User) Order Number: TD/076/0L-P0/04/14/WAL
Date: April 04, 2014 Signature: ~~(]~

Date oflssuance Don Conner, Crosby Quality Assurance Manager
~/
Section 5:
3rd Party NDT Report
Phone : 6221-5565 8270 Fax : 6221 5565 7271

THOROUGH EXAMINATION REPORT
This report complies with the requirements of The Lifting Operations and Lifting Equipment Regulations 1998
Report No. : Color Code : Job No. : Date of Report :

RPT/SPT/JKT/2024/II/3457B-4/014 - Rev1 Green 3457B-4 16-Feb-2024
Company for whom examination was made: Location of where examination took place:
PT. TD ENERGY SERVICES TD ENERGY SERVICES C/O PT Bhanda Ghara Rekasa Boulevard
Heartline Center Building 5th Floor Jl.Pematasari 1000 Villa Permata, BGR No. 1 Jl. Perintis Kemerdekaan, Kelapa Gading Barat -
Lippo Karawaci - Tangerang 15810 Indonesia Kelapa Gading Jakarta Utara
*Key
A B C D E F ND SNCR NF SC
See Non-
Exceptional Other written
Installation 6 Monthly 12 Monthly 5 Yearly No defect conformance Not found Scrapped
circumstance scheme
report
Serial Number Description SWL
BSL 16695 / LNG 015 Gas Bottle Rack

SN. Manufacture: H001456
Dimensions : 1,270 (L) X 1,150 (W) X 2,285 (H) mm Tare Mass : 700 Kg
Manufacturer : Dalian CIMC Logistics Equipment Co., Ltd. Payload : 1,800 Kg
Date of Manufacturer : Mar, 2014 Max. Gross Mass : 2,500 Kg
Certificate No : SHI1483324-05
14/0887/1-4 4 Leg Wire Rope Sling To DNV2.7-1:2013. Legs Ø 18 mm X 1.700 mm. WLL:
M/19/0876/1 6X36 WS IWRC. Galv Fitted to A347 1 1/8" Master Link. 11.3 tonne @ 0-25°
Certificate No. : WAL/C/14/0887
WAL/14/1491 4 ea Safety Pin Bow Shackle WLL: 4.75 tonne

WAL/14/1492 Manufacturer : Crosby
WAL/14/1493 Size : 3/4”
WAL/14/1494 Batch No : 5NO
Thorough Examination Examination

Status* Safe to use
Reason for* Date of last Date of this Date of next Scope Findings
13-Jan-2022
C 15-Feb-2024 14-Feb-2025 VN None ND Yes
By Akura
Examined in accordance : DNV-GL-ST-E271

Name of person who carried out the examination : Shoni Alam Arista
Position & Qualification of person who carried out the examination : Inspector - LEEA Registration Number : 023222
Signed :
Authenticating by : Ainur Roziq

Position : Inspection Coordinator
Signed :
Dokumen ini dianggap bukan dokumen terkendali jika sudah diunduh atau dicetak Form No. F-OPR-SPT-07.17.02
PT. Survey Inspeksi Audit Pratama Tekindo (SIAPTEK) Tanggal Terbit Dokumen 28 Desember 2023
Website: www.siaptek.com | Email: info@siaptek.com Page 1 of 1
OFFSHORE CONTAINER CHECKLIST
Report No. : Color Code : Unit No. : Date of Report :

RPT/SPT/JKT/2024/II/3457B-4/014 - Rev1 Green BSL 16695 / LNG 015 16-Feb-2024
Requires
Area Checked Satisfactory Not applicable Comments
attention
Document information
Certificate of Conformity (CoC) Certificate No : SHI1483324-05
Previous Inspection Report
Other (specify)
Physical markings
MGW, Payload, Tare Weight
Identification number(s)
Perimeter markings
Non-slip roof
ID number – roof & sides
Other markings (specify)
External visual examination
Lifting point alignment
Lifting point condition
Pad eyes measurement
Manufacturer Data Plate
Sides / roof
Corner posts
Surface condition
Undersides no access to perform
Forklift pockets
Doors
Surface condition
Hinge security / lubrication
Seals
Locking security
Internal visual examination
Floor plate and welds
Lashing points
Structural members
Damage / corrosion
Tie down points
Open top box drainage
Lifting sets component
Marking
Lifting sets component 4 Legs Sling After Repair ( 1 Legs Sling Exchange)
Certificate of Conformity (CoC)
OFFSHORE CONTAINER CHECKLIST

Pad Eye Measurement (mm)

Item / SN# DH Thickness
PE-01 23.54 25.33
PE-02 23.47 25.41
PE-03 23.59 25.37
PE-04 23.32 25.28
Shackles Measurement (mm)
Item / SN# Pin dia. (B) Inside Width (A)
WAL/14/1491 22.26 32.11
WAL/14/1492 22.21 32.15
WAL/14/1493 22.35 32.21
WAL/14/1494 22.11 32.24
4-Legged Sling (mm)
- Master link (top link on top runner - if any)
Master Link
A -
B -
C -
G -
- Master link + Intermediate Link
Master Link Intermediate Link
A 22.22 -
B 97.83 -
C 181.18 -
D - 21.43
E - 162
F - 95.23
G - -
S/N of Caliper : 2211223419 Date of Calibration : 18-Apr-2023
PHOTOGRAPHIC OF EXAMINATION

Fig. 1 View of unit Fig. 2 View of manufacture plate
Fig. 3 View of inspection plate unit Fig. 4 View of inspection plate lifting sets
Doc. ID : F-OPR-SPT-01.18.02
Revision No : 02
MAGNETIC PARTICLE INSPECTION REPORT
Effective Date 28 Desember 2023
Client : PT. TD ENERGY SERVICES Report No. : RPT/NDT/SPT/JKT/2024/II/3457B-4/014A - Rev1

Client Address : Heartline Center Building 5th Floor Jl.Pematasari Procedure No. : IK-OPR-SPT-12.1.2
1000 Villa Permata,
Lippo Karawaci - Tangerang 15810 Indonesia
Location of Inspection : TD ENERGY SERVICES C/O PT Bhanda Ghara Rekasa Refer Boulevard
to PO : -
BGR No. 1 Jl. Perintis Kemerdekaan, Kelapa Gading Barat -
Date of Inspection : 15-Feb-2024 Date of Last - : 13-Jan-2022
Thorough Inspection
Drawing No. : - Welding process : -
Material spec. : Ferromagnetic Test Specification : BS EN ISO 17638 : 2016
Light type : Natural Light intensity : -
Contrast paint : Magnaflux WCP-2 Particle Ink : Magnaflux Ink 7HF
Batch no. of Contrast Paint : 2006261 Exp. Date : Jun 2025 Batch no. Particle Ink : 200223 Exp. Date : Mar 2025
MPI Unit : Yoke Prods Coil Serial No. : 4667
Date of calibration : 15-Feb-2024
Calibrated weight : Serial No. : SPT-BK-005 - SPT-BK-008 Date of Calibration : 12-Sep-2023
Type of current : AC Permanent HWDC / HWAC Others ( )
Type of inspection : Dry Wet Fluorescent Non Fluorescent
Method examination : Continuous Residual
Surface condition : As welded As forged As rolled Others
Surface preparation : Grinding Machining Blasting Brushing
Time of inspection : After welding After hydrotest After PWHT Others (After Clean)
Scope of inspection : Base metal Edge prep Back chipping
Weld part Repair weld Others ( )
Type of
Description Area Inspected Thickness (mm) Accepted Rejected Remarks
discontinuity
Pad Eye-01 25.33 P - - -
Gas Bottle Rack Pad Eye-02 25.41 P - - -
BSL 16695 / LNG 015 Pad Eye-03 25.37 P - - -
Pad Eye-04 25.28 P - - -
Pictures:
Pad Eye-01 Pad Eye-02 Pad Eye-03 Pad Eye-04
Acceptance Criteria : BS EN 10228-1: 2016, BS EN 1677-4: 2000 + A1: 2008

Notes : √ : Ok , X : Not Ok , N/A : Not Applicable
Result : No relevant indication found during inspection
Inspector Name & Signature : Shoni Alam Arista Inspector Certification : ASNT NDT Level II
Date : 16-Feb-2024 Report to be kept 3 years minimum

Except for cases of proven negligence of fraud by SIAPTEK, the Client agrees to hold harmless and indemnify SIAPTEK and its inspectors, technicians, officers, employees, agents or subcontractors against all claims (actual or threatened) by them and by any third party for loss, damage or expense of
whatsoever nature including all legal expenses and related costs and however arising relating to the performance, purported performance or non-performance of the services or out of or in connection with Client’s product, process or service the subject of the certification including, without limitation, product
liability claims. The total liability of SIAPTEK to the Client in respect of any claims for loss, damage or expense of any nature and howsoever arising shall be limited, in respect of any one event or series of connected events, to an amount equal to US$ 1,000 (excluding Value Added Tax thereon).
Registered :
Dokumen ini dianggap bukan dokumen terkendali jika sudah diunduh atau dicetak
PT. Survey Inspeksi Audit Pratama Tekindo (SIAPTEK)
Website: www.siaptek.com | Email: info@siaptek.com
Revision No : 02
Client : PT. TD ENERGY SERVICES Report No. : RPT/NDT/SPT/JKT/2024/II/3457B-4/014B

1000 Villa Permata,
to PO : -
Date of Inspection : 15-Feb-2024 Date of Last - : -
Thorough Inspection
Type of
discontinuity
4 leg wire rope sling

All Body - P - - -
14/0887/1-4
Pictures:
Acceptance Criteria : BS EN ISO 23278: 2015


Registered :
Revision No : 02
Client : PT. TD ENERGY SERVICES Report No. : RPT/NDT/SPT/JKT/2024/II/3457B-4/014C

1000 Villa Permata,
to PO :
Date of Inspection : 15-Feb-2024 Date of Last - : 13-Jan-2022
Thorough Inspection
Type of
discontinuity
4 ea Safety Pin Bow Shackle
S/N:
All Body - P - - -
WAL/14/1491, WAL/14/1492,
WAL/14/1493, WAL/14/1494
Pictures :
Acceptance Criteria : BS EN 10228-1: 2016, BS EN 13889: 2003


Registered :
Section 6:
Inspector Certificates
Phone : 6221-5565 8270 Fax : 6221 5565 7271

Lifting Equipment Engineers Association
Examination Diploma
This is to certifg that
ShoniHlam Hrista
passed the Fssociation's examination
in the subject ot
0ffshore Containers
held on
22 Januarg 2015
Chief Examlnea
Engineers Association is a technical trade association based in lhe lJnited Kingdom

PSIR - Gas Bottle Rack - BSL 16695 - LNG 015

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PSIR - Gas Bottle Rack - BSL 16695 - LNG 015

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PRE-SHIPMENT INSPECTION REPORT OF

Contract No: 4420003008 RFI Number: 3596.LE.L2.II.2024

Date of Inspection: February 28th, 2024

3. In accordance with an examination scheme? YES √ NO

Is the above a defect which is of immediate danger to persons? YES NO √

Inspection result: IS THIS EQUIPMENT SAFE TO USE? YES √ NO

Contract No: 4420003008 RFI Number: 3596.LE.L2.II.2024

QUALITY ASSURANCE &

Date of Inspection: February 28th, 2024

Form No.: LF-004-PSIPR

Contract No: 4420003008 RFI Number: 3596.LE.L2.II.2024

QUALITY ASSURANCE &

Date of Inspection: February 28th, 2024

Form No.: LF-004-PSIPR

Contract No: 4420003008 RFI Number: 3596.LE.L2.II.2024

QUALITY ASSURANCE &

Date of Inspection: February 28th, 2024

Form No.: LF-004-PSIPR

A4 Valid Offshore Container Report of thorough examination (12 monthly) √ √ -

Issued By PT. Siaptek

Issued By PT. Siaptek

Is this Offshore Container conforming to Standard?* C: Conformance NC: Non Conformance

Inspector Name: Pradhipta Winahyu Nurobbi

Qualification: LEEA Part 1, LEEA Part 2, CI, WI

BSL16695 (Gas Bottle Rack)

Section 1: Approval Certificates

Mail: sales@tdenergyservices.com Web: www.tdenergyservices.com

Mail: sales@tdenergyservices.com Web: www.tdenergyservices.com

Offshore Container Construction Certificate

Issued at SHANGHAI on MARCH 17, 2014

A member of the Lloyd's Register Group

Form 5216F (2014.01)

Mail: sales@tdenergyservices.com Web: www.tdenergyservices.com

Mail: sales@tdenergyservices.com Web: www.tdenergyservices.com

MILL TEST CERTIFICATE

OF BS EN 12385-4:2002 ( 1960 N/mm©+ )

TO MESSRS PT WIGUNA ARTHA LESTARI

MATERIAL DESCRIPTION DRAWN GALVANIZED STEEL WIRE ROPE

06 X 36(WS) + IWRC 1,440.00 M X 2 REEL

6-7 SAMPLING NO. 6

BREAKING STRENGTH 226.00 kN SAMPLE BROKE AT 249.34 kN

WT OF ZINC COATING OF OUTER WIRE MIN. 85.000

ROPE LAY RHRL LAY LENGTH 115.30 mm

CHEMICAL ANALYSIS OF WIRE ROD

DATE OF SAMPLE TEST

Stock No: 1258142

For Product Delivered To: PT. TD Energy Services

Customer (User) Order Number: TD/076/0L-P0/04/14/WAL

April 05, 2014

Mail: sales@tdenergyservices.com Web: www.tdenergyservices.com

Stock No: 1019515

For Product Delivered To: PT. TD Energy Services

Customer (User) Order Number: TD/076/0L-P0/04/14/WAL

Date: April 04, 2014 Signature: ~~(]~

Mail: sales@tdenergyservices.com Web: www.tdenergyservices.com

Report No. : Color Code : Job No. : Date of Report :

BSL 16695 / LNG 015 Gas Bottle Rack

WAL/14/1491 4 ea Safety Pin Bow Shackle WLL: 4.75 tonne

Thorough Examination Examination

Examined in accordance : DNV-GL-ST-E271

Authenticating by : Ainur Roziq

Report No. : Color Code : Unit No. : Date of Report :