PT.

SUCOFINDO

OVERALL COMMENT & TEST LOAD RECOMMENDATION

LIFTING EQUIPMENT DATA

Owner : PT. Pertamina Hulu Rokan

Location : Automotive Shop Duri

Tag No. : 4 x 1302

Manufacturer : Unic Furukawa

Model : UR-804-1

Serial No. : E 000106

Type : Truck Crane Telescopic Boom

SWL : 8,2 Ton

Length of Boom : 4,3 - 12,8 m

Part Line No. : 5 PL

Date of Inspection : 30-Nov-2023

Generally was found in a good condition and fit, and further ready for function testing and load testing

B. TEST LOAD RECOMMENDATION

Based on the document review and the inspection result, it is recommended that the above said lifting
equipment to be tested at 8,2 TON (maximum design load capacity)

The sequence of load testing in another form.

Date of Load Test : 30-Nov-2023

Prepared by Approved by Verified by

Ronny
PT. Sucofindo PT. Pertamina Hulu Rokan MIGAS
 PT. SUCOFINDO
DOCUMENT REVIEW
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

No Document Title Document No. Remarks

Prev Book
1. Manufacture Data Report Comply
4 x 1302

Prev Book
2. Crane Data Sheet for Mobile Crane Comply
4 x 1302

Prev Book
3. Operating Instruction of Mobile Crane Comply
4 x 1302

NDT Procedure PT. Irsindo

4. NDT Procedure Comply
Doc No. IP-AWS-MT-02

NDT Personal Cert. No.1536/MT-

II/SU/2023 No.1537/PT- Comply
II/SU/2023
5. Certificate of NDT Personal & NDT Report

NDT Report No. Comply

All document above reviewed by …………………………

Prepared by Approved by

Ronny
PT. Sucofindo PT. Pertamina Hulu Rokan
 PT. SUCOFINDO
PHYSICAL INSPECTION RECORD
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

Body
No. Part Name Inspection For Result Remarks
1 Body Condition
Front side crack, corrosion Satisfactory -
Rear side crack, corrosion Satisfactory -
Left side corrosion, lubrication Satisfactory -
Right side corrosion, lubrication Satisfactory -
Roof corrosion, crack Satisfactory -

Cabin and Interior

No. Part Name Inspection For Result Remarks
1 Cabin
Frame corrosion, crack, distortion Satisfactory -
Windows, door corrosion, crack, distortion Satisfactory -
Lubrication level, contamination Satisfactory -
Engine mounting fit, wear, crack Satisfactory -
Safety guard fit, distortion, safety Satisfactory -
Muffler, spark arrester fit, leakage, safety Satisfactory -
Air inlet fit, distortion, function Satisfactory -
Emergency shutdown function Satisfactory -
Engine Cover function Satisfactory -
2 Control system
Control Linkeage and lever function Satisfactory -
Platform, ladder corrosion, crack, distort, fit Satisfactory -
Handrail corrosion, crack, distort, fit Satisfactory -
Mirror instalation, function Satisfactory -
Horn alarm function Satisfactory -
Windshield, wiper function Satisfactory -
Pedal, push button function, fit Satisfactory -
Operation signal instalation Satisfactory -
Lubrication gauge function Satisfactory -
Pressure gauge function Satisfactory -
Amp. Voltmeter function Satisfactory -
Engine temp. gauge function Satisfactory -
Speedometer function Satisfactory -

Main Carrier Chassis and Traveling Mechanism

No. Part Name Inspection For Result Remarks
1 Chassis / Car body corrosion, crack Satisfactory -
2 Carrier Wheel
Front wheel wear, alignment Satisfactory -
Drive wheel wear, alignment Satisfactory -
Non prime wheel wear, alignment Satisfactory -
3 Axle mounts front and rear tighten, function Satisfactory -
4 Springs, suspension system no bent, tighten Satisfactory -
5 Parking Brake function Satisfactory -
 PT. SUCOFINDO
Jl. Cisanggiri I No.8 Kebayoran Baru
PHYSICAL INSPECTION RECORD
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

Main Carrier Chassis and Traveling Mechanism

No. Part Name Inspection For Result Remarks
6 Outrigger Extension and Retraction Cylinders tighten, leaks Satisfactory -
7 Outrigger Vertical Jacks Cylinders function, tighten, leaks Satisfactory -
8 Outrigger Pads function, tighten, leaks Satisfactory -
9 Outrigger Control System Levers lubrication, tighten Satisfactory -
10 Electrical wiring and fuse tighten, allignment Satisfactory -
11 Front / Rear Bumper Bars tighten, allignment Satisfactory -
12 Counterweight Mounting tighten, allignment Satisfactory -

Telescopic Boom
No Part Name Inspection For Result Remarks
1 Eye Plate for Boom Foot Pin crack, corrosion
- Welding to Upper Structure crack, corrosion Satisfactory -
2 Boom Foot Pin wear, alignment Satisfactory -
3 Lower Section Telescopic Boom lubrication, corrosion, distortion, crack Satisfactory -
4 2nd Section Telescopic Boom lubrication, corrosion, distortion, crack Satisfactory -
5 3rd Section Telescopic Boom lubrication, corrosion, distortion, crack Satisfactory -
6 4th Section Telescopic Boom lubrication, corrosion, distortion, crack Satisfactory -
7 5th Section Telescopic Boom lubrication, corrosion, distortion, crack N/A
8 Boom Lift Cylinder wear, leak, function
Pin Connection wear, alignment Satisfactory -
Welding Eye Plate to Boom & Structure corrosion, crack, wear Satisfactory -

Slewing Ring / Turntable

No Part Name Inspection For Result Remarks
1 Upper body to lower body corrosion, distortion, crack
- Mounting (bolting or welding) corrosion, distortion, crack Satisfactory -
- Welding to Bearing Race Base Plate corrosion, distortion, crack Satisfactory -
2 Slewing Ring slack, broken bolt
- Bearing lubrication Satisfactory -
- Gear Box leaks, deterioration Satisfactory -
- Drive wear, alignment Satisfactory -
3 Slewing Lock wear, function Satisfactory -
4 Slewing Brake function Satisfactory -
 PT. SUCOFINDO
PHYSICAL INSPECTION RECORD
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

Hydraulic System Prime Mover

No. Part Name Condition No. Part Name Condition
1 Charging Tank Satisfactory 1 Fuel Tank Satisfactory
2 Charging Pump Satisfactory 2 Fuel Line Satisfactory
3 High Pressure Hose Satisfactory 3 Fuel Filter Satisfactory
4 Low Pressure Hose Satisfactory 4 Deep Stick for Lubrication Oil Satisfactory
5 Accumulator N/A 5 Lubrication Oil Cleanliness Satisfactory
6 Accumulator Pressure N/A 6 Lubrication Oil Filter Satisfactory
7 Nitrogen Accumulator Press. N/A 7 Lubrication Oil Cooler Satisfactory
8 Control Valve Satisfactory 8 Radiator Satisfactory
9 Three way Valve Satisfactory 9 Radiator Mounting Satisfactory
10 Cooler Satisfactory 10 Radiator Cap & Warning Sign Satisfactory
11 Reservoir Tank Satisfactory 11 Temperature Gauge of Water Satisfactory
12 Return Strainer Satisfactory 12 Water Pump Satisfactory
13 Suction Strainer Satisfactory 13 Water Line Satisfactory
14 Fan Satisfactory
Wire Rope, Hook Block & Sheaves 15 Fan Drive Accessories Satisfactory
No. Part Name Condition 16 Fan V-Belt Satisfactory
1 Load Line Satisfactory 17 Fan Cover Satisfactory
2 Load Line Dead End Satisfactory 18 Air Intake Filter Satisfactory
3 Fast Line N/A 19 Turbo Charger Satisfactory
4 Fast Line Dead End N/A 20 Muffler (Spark Arrester) Satisfactory
5 Boom Line N/A 21 Exhaust Expansion Joint Satisfactory
6 Boom Line Dead End N/A 22 Starting Motor Satisfactory
7 Pendant N/A 23 Normally Shut-Off Satisfactory
8 Pendant Dead End N/A 24 Emergency Shut-Off Satisfactory
9 Sheaves Hook Block Satisfactory 25 Kick Valve Satisfactory
10 Sheaves Load Line Satisfactory 26 Coupling/Clutch Satisfactory
11 Sheaves Fast Line N/A 27 Motor & Gear Box Hoist Satisfactory
12 Sheaves Boom Line N/A 28 Motor & Gear Box Boom Satisfactory
13 Hook Block Fast Line N/A 29 Motor & Gear Box Swing Satisfactory
14 Hook Block Boom Line N/A 30 Electrical Distribution Panel Satisfactory

Safety Device Winch

No. Part Name Condition No. Part Name Condition
1 Emergency Load Brake N/A 1 Fast N/A
2 Pawl & Rachet N/A 2 Load Satisfactory
3 PTO Satisfactory 3 Boom N/A
4 Anti Two-Blocking Satisfactory 4 Fast Line Brake N/A
5 Boom Hoist Limited Switch N/A 5 Load Line Brake Satisfactory
6 Swing Brake Satisfactory 6 Boom Line Brake Satisfactory
7 Parking Brake Satisfactory 7 Gear Oil Fast N/A
8 Alarm System Satisfactory 8 Gear Oil Load Satisfactory
9 Hook Safety Latch Satisfactory 9 Gear Oil Boom Satisfactory
10 Boom angle indicator Satisfactory
11 Load rating chart Satisfactory
12 Boom Rest Satisfactory
 PT. SUCOFINDO
DETAIL SEQUENCE OF LOAD TESTING
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

Main Hoist
Boom Load Boom Safe Working Load
Radius
Angle Test Length (SWL) Remarks
(m) (deg.) (kg) (m) (kg)

4,5 48 3200 7,2 8200 100% SWL

3 30 5200 4,3 8200 100% SWL

2,5 40 8200 4,3 8200 100% SWL

Auxiliary Hoist
Boom Load Boom Safe Working Load
Radius
Angle Test Length (SWL) Remarks
(m) (deg.) (kg) (m) (kg)

Note :

Inspected by Approved by

PT. Sucofindo PT. Pertamina Hulu Rokan

 PT. SUCOFINDO
POST PHYSICAL INSPECTION (AFTER LOAD TESTING)
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

No. Item Result of Inspection Remarks

1 Boom Base
Structure Satisfactory -
Welding Satisfactory -
2 Telescopic Boom
Lower Section Satisfactory -
2nd Section Satisfactory -
3rd Section Satisfactory -
4th Section Satisfactory -
5th Section N/A
3 Load Block
Hook Satisfactory -
Bearing Satisfactory -
Pin Satisfactory -
4 Wire Rope (Running)
Dead End Satisfactory -
Physic Satisfactory -
5 Wire Rope (Standing) N/A
Dead End
Physic
6 Sheave
Shaft Satisfactory -
Physic Satisfactory -
7 Slewing Bearing
Bolting Satisfactory -
8 Hydraulic
Pump Satisfactory -
Hose Satisfactory -
9 Electrical
Motor Satisfactory -
Cable Satisfactory -

Note :

Inspected by Approved by

PT. Sucofindo PT. Pertamina Hulu Rokan

 PT. SUCOFINDO
INSPECTION PICTURE
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

Plant Number Name plate

Outrigger Turn table base

Hook block Winch

Inspected by Approved by

PT. Sucofindo PT. Pertamina Hulu Rokan

 PT. SUCOFINDO
LOAD TEST PICTURE
Owner : PT. Pertamina Hulu Rokan Tag No. : 4 x 1302
Location : Automotive Shop Duri Model : UR-804-1
Date of Inspection : November 30, 2023 Serial No. : E 000106

Dynamic load test conducted at 100% SWL = 3200 kg

Dynamic load test conducted at 100% SWL = 5200 kg

Static overload test conducted at 100% SWL = 8200 kg

Inspected by Approved by

PT. Sucofindo PT. Pertamina Hulu Rokan