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IJIN LOWBOY/FLATBED/TRUCK BERMUATAN/CRANE TRUCK

MELINTAS DI JEMBATAN UNDERPASS KM – 14 DAN PORT


Saya yang bertandatangan dibawah ini :

Nama : Jimmy Parandan

Jabatan : Earthwork Engineer

Perusahaan : PT. Indexim Coalindo

Mengajukan ijin melintas jembatan Underpass KM – 14 dan PORT dengan rincian :

Tgl Diajukan : 02 November 2023

Tgl Digunakan : 05 November 2023 – 04 Desember 2023

UNIT : LOWBOY/FLATBED/TRUCK/CRANE TRUCK (Coret yang tidak perlu)

Muatan : 1. Exca 30 T 2. Exca 20 T 3. Dozer D85ss 4. Compactor


Dimensi : BERAT : 30 dan 20 TON
TINGGI : Exca 3.4 / 5.1 (LB KPP), 3.4/4.1 (LB UDU) METER
Exca 3 / 4.8 (LB KPP), 3/3.8 (LB UDU) METER
Dozer 3 /4.6(LB KPP), 3/3.7 (LB UDU) METER
Compactor 2.8/4.5 (LB KPP), 2.8/3.5 (LB UDU) METER
LEBAR : 3 METER
Untuk persetujuan ini, saya lengkapi dengan Job Safety Analisys (JSA) Terlampir.

Terimakasih

Pemohon Mengetahui Menyetujui

Jimmy Parandan Sahrial Nugroho Hendrato Agung G


Earthwork Engineer Superintendent Earthwork Kepala Teknik Tambang

Catatan :

1. Pemohon adalah pengawas yang melakukan mobilisasi material /unit


2. Mengetahui Head Dept/ Manager Untuk PT Indexim, Atau PJO untuk Kontraktor
LOWBOY KPP
LOWBOY UDU
LOWBOY KPP
LOWBOY UDU
LOWBOY KPP
LOWBOY UDU
LOWBOY UDU
LOWBOY KPP
LOWBOY KPP

LOWBOY UDU
Ijin Melintas Lowboy Dept.Project
Final Audit Report 2023-11-03

Created: 2023-11-02

By: eSign Project (esign.project@indexim.co.id)

Status: Signed

Transaction ID: CBJCHBCAABAAGfWb2xzcbHbzdGUH0fs8Su4vvb_CwAU6

"Ijin Melintas Lowboy Dept.Project" History


Document created by eSign Project (esign.project@indexim.co.id)
2023-11-02 - 11:10:35 PM GMT- IP address: 103.160.150.66

Document emailed to jimmy.parandan@indexim.co.id for signature


2023-11-02 - 11:11:22 PM GMT

Email viewed by jimmy.parandan@indexim.co.id


2023-11-02 - 11:14:32 PM GMT- IP address: 104.47.110.62

Signer jimmy.parandan@indexim.co.id entered name at signing as Jimmy Parandan


2023-11-02 - 11:15:46 PM GMT- IP address: 103.160.150.66

Document e-signed by Jimmy Parandan (jimmy.parandan@indexim.co.id)


Signature Date: 2023-11-02 - 11:15:48 PM GMT - Time Source: server- IP address: 103.160.150.66

Document emailed to sahrial.nugroho@indexim.co.id for signature


2023-11-02 - 11:15:50 PM GMT

Email viewed by sahrial.nugroho@indexim.co.id


2023-11-02 - 11:16:53 PM GMT- IP address: 104.47.110.62

Signer sahrial.nugroho@indexim.co.id entered name at signing as Sahrial AN


2023-11-02 - 11:32:24 PM GMT- IP address: 103.160.150.66

Document e-signed by Sahrial AN (sahrial.nugroho@indexim.co.id)


Signature Date: 2023-11-02 - 11:32:26 PM GMT - Time Source: server- IP address: 103.160.150.66

Document emailed to didik jati mulyanto (didik.jati@indexim.co.id) for signature


2023-11-02 - 11:32:29 PM GMT

Email viewed by didik jati mulyanto (didik.jati@indexim.co.id)


2023-11-03 - 2:38:43 AM GMT- IP address: 104.47.110.62
Document e-signed by didik jati mulyanto (didik.jati@indexim.co.id)
Signature Date: 2023-11-03 - 2:39:43 AM GMT - Time Source: server- IP address: 103.160.150.66

Agreement completed.
2023-11-03 - 2:39:43 AM GMT

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