FORM REPORT

Customer HEXINDO Part Number

Component Name PISTON TRACK ADJUSTER Inspection/Report Date
Unit Model EX 3600 Inspection - Repair AFTER BEFORE
Serial Number Job Number
Control Number Order Number
KETERANGAN ATAS ITEM YANG DI REPAIR / DIBUAT STANDARD DIMENSION
(Gambar Dimensi & Ukuran) (unit mm)
B¹
C¹ A Ø 271.910 ~ 271.940

A¹
E¹ B Ø 279.600 ~ 279.630
B²
C 7.980 ~ 8.020
A²
E² D 9.980 ~ 10.020
B³
C²
E 30.000 ~ 30.200

MEASUREMENT RESULT
I. Dimension A1 II. Dimension A2
DIM 1 2 3 DIM 1 2 3
X X
Y Y
Z Z

III. Dimension B1 IV. Dimension B2 V. Dimension B3 VI. Dimension C1

DIM 1 DIM 1 DIM 1 DIM 1
X X X X
Y Y Y Y
Z Z Z Z

VII. Dimension C2 VIII. Dimension D IX. Dimension E1 X. Dimension E2

DIM 1 DIM 1 DIM 1 DIM 1
X X X X
Y Y Y Y
Z Z Z Z

REMARKS RECOMENDATION
1 1
2 2
3 3
4 4
5 5
WELDING THERMAL COATING MACHINING OTHERS
CHECKED BY APPROVED BY :

DIMAS PURWANTO NURSOLI

QC ENGINEER SPV QC
SSC-FORM-001/QC/REV.01