TITLE: Equipment Gate Pass Form

ASSOCIATED PROCEDURE NO.: HFY-Sec-4.3.5

PROCEDURE TITLE: Equipment Pass and Vehicle & Visitor Entry Request Procedure v4.1

EQUIPMENT GATE PASS RIG SITES

‫أستمارة اخراج المواد‬
SECTION 1 – Applicant Details
Company Antonoil
Name Karrar Ali
Email Karrar.h@antonoil.com
Phone Number 0783 497 0415
SECTION 2– Consignment Supervisor
The assigned employee responsible for ensuring the vehicle is only loaded with the equipment listed
in Section 7 Cargo & Sign off Section 9.
Name Ali Mohammed
Email AM.Jassim@antonoil.com

Phone Number 07808844943

SECTION 3 – Transportation Details

a Date / ‫التاريخ‬ 04/06/2024 04/06/2024
b From / ‫من‬ HF026 HF026
c To / ‫الى‬ Halfaya Basecamp ‫مخيم الحلفايا‬
Antonoil ‫انتون اويل‬
d Driver Name / ‫أسم السائق‬ Riyadh imad ‫رياض عماد‬
e Number Plate / ‫رقم لوحة التسجيل‬ 328- Bassra 328- ‫بصره‬
SECTION 4 – Contractor Authorization.
To be completed by management of company dispatching the equipment.
If this is PetroChina, only Section 5 required to be completed
CONTRACTOR AUTHORIZATION
Name Karar Ali
Email Karrar.h@antonoil.com
Phone Number 07834970415

Signature

SECTION 5 – PetroChina Authorization

To be completed by the nominated focal point for the contract-holding department.
Refer to section 6 for additional authorization if the cargo contains hazardous material
PETROCHINA DEPARTMENT AUTHORIZATION
‫ترخيص قسم البتروجاينا‬
Name Zulfiqar Ali Jatoi
‫االسم‬ ‫ذو القار علي جتزي‬
Department Well Services Department
‫القسم‬ ‫ويل سيرفس‬
Email / ‫البريد االلكتروني‬ zulfiqarj@petrochina-hfy.com
Phone Number / ‫رقم الهاتف‬ 07834958137

Signature
‫التوقيع‬

SECTION 6 – PetroChina HSE Environmental Authorization

To be completed by the nominated HSE Environment focal point
PETROCHINA HSE ENVIRONMENT AUTHORIZATION
Name
HSE Department
Email
Phone Number
 TITLE: Equipment Gate Pass Form
ASSOCIATED PROCEDURE NO.: HFY-Sec-4.3.5
PROCEDURE TITLE: Equipment Pass and Vehicle & Visitor Entry Request Procedure v4.1

Signature

SECTION 7 – CARGO
 Use Description for Cargo information in full detail
 Use Remarks for additional Cargo information
 Important: Type both English & Arabic language

Item Description / ‫التفاصيل‬ QTY Remarks / ‫ألمالحظات‬

4-inch hose
1 4
‫ بوصة‬4 ‫هوز‬
cement piers
2 2
‫صبات كونكريت‬
electric generator
3 1
‫مولد كهرباء‬
warning board
4 7
‫عالمات سالمة تحذيرية‬
Iron bar for safety line
5 12
‫اوتاد معدنية للسالمة‬
blowout prevents pipe
6 2
‫انابيب مانعة للتسرب‬
Flanges
7 3
‫فلنجات‬
Hammer valve
8 6
‫صمام مطرقي‬
tee junction
9 4
)‫توصاله انابيب (عكس‬
high pressure rotary elbow
10 5
) ‫انابيب ضغط عالي ( ايلبو‬
injector chain
11 2
)‫سلسلة الحاقن (االنجكتر‬
Maintance room
12 1
‫غرفة صيانة‬
bench screw
13 1
‫ملزمة نضدية‬
SCBA
14 4
‫اقنعة تنفس‬

SECTION 8 – Security Approvals Rigs & Wells

NAME SIGNATURE & STAMP
Barry Jones
Security Superintendent (Rigs & Wells)
Authorized on confirmation of sponsoring PCH Dept

Serial Number ANT-04062024001

SECTION 9 – Cargo Check

CONSIGNMENT SUPERVISOR SIGNATURE

Ali Mohammed
2024-06-04