Space for Stamp: IP/OE

RETURN CODE

Revision History
Rev Revision Date Created Checked Approved Brief Description
by by by
1 21 JUN 2022 HR MZ AL For Information
0 07 AUG 2019 HR BW BS Issued for Construction
D 05 SEP 2018 HR BW BS Fourth Issue
C 03 SEP 2018 HR BW BS Third Issue
B 21 AUG 2018 HR BW BS Second Issue
A 15 AUG 2018 HR BW BS First Issue
Description of Current Revision:

Owner:

Owner’s Engineer: Contractor:

Project
TAMBAK LOROK COMBINED CYCLE
POWER PLANT BLOCK 3 PROJECT
WITH NET DEPENDABLE CAPACITY OF 600 – 850 MW.
SEMARANG – CENTRAL JAVA
Subject:
INSPECTION AND TEST PLAN (ITP) FOR CIVIL WORKS
Issue Purpose: Responsible Dept:
FOR CONSTRUCTION QUALITY ASSURANCE & CONTROL
Originator:
HUTAMA KARYA
Originator Document No: Originator Rev:
ITP 0001/QC/HK/TL/2018
0001/QC/HK/TL/201 1
Project Document No: Rev: Sheet.

TBL/31/P/06a
TBL/31/P/06a----001/QP/001 1 32
Title of Document / Drawing: Inspection Test Plan (ITP) for Civil Work Kinds of Status:

Approval Category

I T E M S T A T U S [O / C / P]
P R I O R I T Y [H]
Document Number: ITP 0001-QC-HK-TL-2018 A = Approved
H = High Priority (High Importance)
B = Approved with Comments
Kornelius Witt Bambang Kardito, Upi Madsupie S, Amin O = Item OPEN C= Not Approved (Rejected)
Reviewed By: I = Information
Muntoha. C = Item completely CLOSED
P = Item CLOSED, but to be checked on Site

EPC Document Transmittal Ref. No.: TBL-LT-MCS-IPS-Q-0082

HIGH
CRS_Document Number_Title_Date: TBL/31/P/06a----001/QP/001 ……………………..8/21/2018 Approval Status A
Review Date: 6-Sep-18
CRS Revision Number: D
EPC's REPLIES - STEP CONSULTANTS /OWNER
No REFERENCE NUMBER SUBJECT / ITEM CONSULTANTS /OWNER COMMENTS - STEP 1 EPC's REPLIES - STEP 1 CONSULTANTS /OWNER COMMENTS - STEP 2 EPC's REPLIES - STEP 2 CONSULTANTS /OWNER COMMENTS - STEP 3 EPC's REPLIES - STEP 4
3 COMMENTS - STEP 4
The signature for all inspection form should be as follow:
Witnessed by Owner Engineer
1 ITP 0001/QC/HK/TL/2018 Inspection Test Plan (ITP) for Civil Work Acknowledged by Owner Revised as per Comment No comments. Closed. C

ITP 0001/QC/HK/TL/2018 -
2 Project information N/A N/A Additional clause should be add in the procedure for Project information, as belows: Added No comments. Closed. C
General

3 F-HK-QC-0001A Inspection One Week Look Ahead Plan N/A N/A Please add one column for reference number for traceability and recording. Added No comments. Closed. C
Please in the procedure should be mention ITP's list for all system for whole plant,
consists of:
1. Substructure of Gas Turbine, Steam Turbine & Generator (GT,ST&G).
2. Superstructure of Gas Turbine, Steam Turbine & Generator (GT,ST&G) (If any).
3. Boiler/HRSG foundation.
4. Flue gas duct.
Please add no.
4 ITP 0001/QC/HK/TL/2018 2. Scope/Application N/A N/A 5. Stack foundation. Added Added No comment. Closed. C
83. Others.
6. Generator transformer foundation.
7. CW Pump House.
8. Wastewater Treatment Station.
9. Water Treatment Station.
………………………………etc.

Anti Corrosion same as

Bituminous Paint as specified
5 4. ITP for Civil Work 1.4. Concrete Work N/A N/A Please add sub-clause for 1.4.3. Anticorrosion Coating No comments. Closed. C
state on ITP Sub-Clause
1.4.2.e.7

ITP for Steel Structure &

Please add clause for 1.7. Superstructure of bulding with detail description (i.e. steel Architectural works of
6 4. ITP for Civil Work General - Additional clause. N/A N/A structure, Structure of wall, Installation of window and door, Decoration work, General building will be submitted in Noted. Closed. C
plastering, Suspended ceiling, Roof work, Thermal insulating layer, etc.) separated Document and
Different ITP Number

7 3. Inspection Category Code WR - Random Witness N/A N/A N/A N/A Please deleted sentence: "No notification of inspection required". Revised as per Comment No comment. Closed. C

Please change inspection category to as details belows:

1.2 Soil Improvement
1.2.1 Preparation
a. Site Clearing and Grading (W)
f. Installation of Geotechnical instrum entation (W)
1.2.2 Installation
c.1. Ground surface preparation (W)
d. Soil Filling (W)
1.3 EARTH WORKS (Excavation & Backfilling)
1.3.1 Excavation
f. Final survey (W)

7 4. ITP for Civil Work General - Inspection Category N/A N/A N/A N/A 1.4.2 Re bar & Form work Installation Revised as per Comment No comment. Closed. C
b.7. Position and Elevation (Survey Report) (W)
d. Concretin
1. Slump test (WR)
2. Temperature (WR)
3. Sampling ( concrete sylinder)(WR)
1.5 Piling Work
1.5.2 Material On Site
a. Quality of material (W)
1.5.3 Installation For Spun Pile
b. Verticality of piles (R)
c. Blow-count (R)
 Title of Document / Drawing: ITP For Civil Work Kinds of Status:

Approval Category

I T E M S T A T U S [O / C / P]
P R I O R I T Y [H]
Originator Document Number: ITP 0001-QC-HK-TL-2018
H = High Priority (High Importance) A = Approved
O = Item OPEN B = Approved with Comments
C = Item completely CLOSED C= Not Approved (Rejected)
Reviewed By: IP/OE Site Team P = Item CLOSED, but to be checked on I = Information
Site
EPC Document Transmittal Ref. No.: TBL-LT-MCS-IPS-Q-3209

HIGH
CRS_Document Number_Title_Date: CRS_TBL/31/P/06a----001/QP/001_23 June 2022 Approval Status

Review Date: June 23, 2022

CRS Revision Number: 1
CONSULTANTS /OWNER CONSULTANTS /OWNER
No REFERENCE NUMBER SUBJECT / ITEM CONSULTANTS /OWNER COMMENTS - STEP 1 EPC's REPLIES - STEP 1 EPC's REPLIES - STEP 2
COMMENTS - STEP 2 COMMENTS - STEP 3
Noted.
Section 1.3.2 e This document purpose is only to improve site condition where
1 Lean Concrete will be used as an option (not necessarily always) C
Field Density Test
instead of field density test.
Space for Stamp: IP/OE
RETURN CODE

Revision History
Rev Revision Date Created Checked Approved Brief Description
by by by

0 21 DEC 2018 AL MZ BS Update Termination Criteria

C 21 APR 2018 AL MZ BS For Approval
B 17 APR 2018 AL MZ BS Revised as per owner comment
A 10 APR 2018 AL MZ BS First Issue
Description of Current Revision:

Owner :

Owner’s Engineer: Contractor:

Project
TAMBAK LOROK COMBINED CYCLE
POWER PLANT BLOCK 3 PROJECT
WITH NET DEPENDABLE CAPACITY OF 600 – 850 MW.
SEMARANG – CENTRAL JAVA
Subject:
WORK PROCEDURE AND METHOD STATEMENT / RISK ASSESSMENT OF PILING WORK
Issue Purpose: Responsible Dept:
FOR CONSTRUCTION CIVIL CONSTRUCTION
Originator:
HUTAMA KARYA
Originator Document No: Originator Rev:
00018A/MS/HK/TL/2018 0
Project Document No: Rev: Sheet.

TBL/31/W/UBF---CCP3/MS/002 0 56
= INDONESIA
PEANVIEIR

i
= Title
of Document | Drawing: WORK PROCEDURE AND METHODE STATEMENT / RISK ASSESSMENT OF PILING |. roams:

0018A/MS/HK/TLI2018 or] g Pe 5 °
B: Batty,
EPC Document Transmittal Ref. No.:| TBL-LT-MCS-IPS-Q-0023
Kaito, Upi Madsupie 5. (£7
~ og
-
Die
mare
ow rcp)
bite be on site Pe
8 Approved with Comments
by?
: |:
tle
HE 3
= |<
a hr

CRS_TBL/31M/UBS_ CCPUMS/002/10-04.2018 Agproved by: Stuart Batty Approval Status =|?

= = oz =
|r
REFERENCE NUMBER |SUBJECT /ITEM EPC's REPLIES - STEP 1 ! |EPcs REPLIES - STEP 2
i
eed io be consider what ype of pile machine. relaled (othe piling area is very close Will oted, Contractor
wil provide vibration In order
to explain what is tools can be use monitoring vibration. * ~~ |* Already explant
General For Approval he monitoring test equipment
for pile load test Please add potential risk that can happen to the existing power Plant No- Potential damage for H|C
activity. (trip/damage) and put mitigation action for this. existing power Plant
Pleasein order (0 pul the piling schedule Noted. The schedule for test pilingwas attached.
Schedule for working pile will be submitted in |* Please Attsched Pile Test Driving Schedule Only * Already Attach Hc
separate transmittal.

Piling QAIQC Documentation (Already added. Hc

Construction Drawing for pile Layout Location of of test piles was mentioned in the WP
page 23. Piling layout for overall working piles. Hc
will be issued in future.
inspection Tes Pian (TF) Already added. Hc
Vibration monitoring of sumounding area Block 3 station Noted, refer to EPG reply above. Hie

(Organization of Constnuction Already added on 10, ORGANIZATION CHART Hc

Réfimitos cima: Already added on 4. STANDARD REFERENCE Hc
Sequence of Work Already added on 9. FLOWCHART
WORK
PILING
Hc[5 |
[Foden til Already on # List | "Drawing/Layout of Pile test driving * Already Attach H|c
tem 4.4 phase Cutling Pile up 10 lem 4.5 Soil Excavation pags 9 of 1515 not in the method
statement for piling, that is construction Method. Noted, already revised. “Certificate * Already Attach HC

[Please completely, af Caters (See Comment) Noted, Already revised. * Lifting Gear Centificate/Certificate Manufacturing * Already Attach H|c

* Page no.1 of 35 Please Change

: For Information shall be For Approval noted H|C

* Please Check Page no.2 of 35 Please Change : For Information shall noted ule
be For Approval
* Please check Page no.3 of 35 Table Contents : Page number item 10 lo
12
Space for Stamp: IP/OE
RETURN CODE

Revision History
Rev Revision Date Created Checked Approved Brief Description
by by by

0 08 AUG 2019 HR BW BS Issued for Construction

B 30 APR 2018 HR BW BS Second Issue
A 10 APR 2018 HR BW BS First Issue
Description of Current Revision:

Owner:

Owner’s Engineer: Contractor:

Project
TAMBAK LOROK COMBINED CYCLE POWER PLANT BLOCK 3 PROJECT
WITH NET DEPENDABLE CAPACITY OF 600 – 850 MW.
SEMARANG – CENTRAL JAVA
Subject:
WORK PROCEDURE OF LIQUID PENETRANT TESTING JOINT PILE WELD
Issue Purpose: Responsible Dept:
FOR APPROVAL Quality Assurance and Control
Originator:
HUTAMA KARYA
Originator Document No: Originator Rev:
0012A/QC/HK/TL/201
/QC/HK/TL/2018 0
Project Document No: Rev: Sheet.

TBL/31/P/06a
TBL/31/P/06a----PP/002 0 22
 Title of Document / Drawing: WORK PROCEDURE OF LIQUID PENETRANT TESTING JOINT PILE WELD Kinds of Status:
Approval Category

I T E M S T A T U S [O / C / P]
P R I O R I T Y [H]
Document Number: 0012A/DOC/HK/TL/2018
A = Approved
H = High Priority (High Importance) B = Approved with Comments
Reviewed By: Stuart Batty, Bambang Kardito, Upi Madsupi S. O = Item OPEN
C= Not Approved (Rejected)
C = Item completely CLOSED
P = Item CLOSED, but to be checked on Site
I = Information
EPC Document Transmittal Ref. No.: TBL-LT-MCS-IPS-Q-0038

Approved by: Stuart Batty

CRS_Document Number_Title_Date: CRS_TBL/31/P/06a----PP/001_18-04-2018 Approval Status A

HIGH
(Site Manager)

Review Date: 18-04-2018

CRS Revision Number: 0

No REFERENCE NUMBER SUBJECT / ITEM CONSULTANTS /OWNER COMMENTS - STEP 1 EPC's REPLIES - STEP 1 CONSULTANTS /OWNER COMMENTS - STEP 2 EPC's REPLIES - STEP 2

The document must be prepared by personnel was certified NDE Level II (minimum) and
1 General Personnel who make procedure All ready done No comment. H C
approved by personnel was certified NDE Level III.
2 General CERTIFICATION OF - Append CERTIFICATION OF COMPLIANCE before list of contens page with format:
COMPLIANCE Revision Date Prepare by, Approved by, Reviewed by,

All ready done No comment. H C

< __NAME__ > < __NAME__ >
NDE Level II NDE Level III
ID No.: _______

3 General Cover Change issue purpose to FOR APPROVAL. All ready done No comment. C
4 General Table of Contents Make table of contents as below:
1. Purpose
2. Scope
3. Application Code and Reference
4. Definitions
5. Qualification and Responsibility
6. Penetrant Materials
7. Procedure
7.1 Surface Preparation
7.2 Pre Cleaning
7.3 Penetrant Application
7.3.1 Temperature
7.3.2 Methods
All ready done No comment. H C
7.3.3 Penetrant (Dwell) Time
7.4 Excess Penetrant Removal
7.5 Drying After Penetrant Removal
7.6 Application of Developer
7.7 Illumination
8. Interpretation of Indication
9. Evaluation and Acceptance Standard
10. Post Examination Cleaning
11. Safety
12. Documentation:
- Exhibit 1 Table T-621 Requirements of a Liquid Penetrant Examination Procedure
- Exhibit 2 Liquid Penetrant Testing Acceptance Criteria
- Exhibit 3 Examination Report
Procedure Contents related with
5 General Please make detail description for every clause was mentioned in the table of content. All ready done No comment. H C
the table of contents.
6 11 Safety Attach Risk Assesment table related to PT work procedure. Noted No comment. H C
7 12 Exhibit 3 Examination Please make the PTR more detail information (see sample in the attachment)
Report/Penetrant Test Report All ready Attacment No comment. H C
(PTR)
Space for Stamp: IP/OE
RETURN CODE

Revision History
Rev Revision Date Created Checked Approved Brief Description
by by by

0 08 AUG 2019 HR BW BS Issued for Construction

B 30 APR 2018 HR BW BS Second Issue
A 10 APR 2018 HR BW BS First Issue
Description of Current Revision:

Owner:

Owner’s Engineer: Contractor:

Project
TAMBAK LOROK COMBINED CYCLE POWER PLANT BLOCK 3 PROJECT
WITH NET DEPENDABLE CAPACITY OF 600 – 850 MW.
SEMARANG – CENTRAL JAVA
Subject:
WELDING PROCEDURE SPECIFICATION & PROCEDURE QUALIFICATION RECORDS
FOR WELDING JOINT PILE
Issue Purpose: Responsible Dept:
FOR INFORMATION Quality Assurance and Control
Originator:
HUTAMA KARYA
Originator Document No: Originator Rev:
0012B/QC/HK/TL/2018 0
Project Document No: Rev: Sheet.

TBL/31/P/06a
TBL/31/P/06a----PP/003 0 47
 WELDING PROCEDURE SPECIFICATION & PROCEDURE QUALIFICATION
Title of Document / Drawing: RECORDS Kinds of Status:
FOR WELDING JOINT PILE Approval Category

I T E M S T A T U S [O / C / P]
P R I O R I T Y [H]
Document Number: 0012B/DOC/HK/TL/2018
A = Approved
H = High Priority (High Importance) B = Approved with Comments
Reviewed By: Stuart Batty, Bambang Kardito, Upi Madsupi S. O = Item OPEN
C= Not Approved (Rejected)
C = Item completely CLOSED
P = Item CLOSED, but to be checked on Site
I = Information
EPC Document Transmittal Ref. No.: TBL-LT-MCS-IPS-Q-0038

Approved by: Stuart Batty

CRS_Document Number_Title_Date: CRS_TBL/31/P/06a----PP/001_18-04-2018 Approval Status A

HIGH
(Site Manager)

Review Date: 18-04-2018

CRS Revision Number: 0
EPC's REPLIES -
No REFERENCE NUMBER SUBJECT / ITEM CONSULTANTS /OWNER COMMENTS - STEP 1 EPC's REPLIES - STEP 1 CONSULTANTS /OWNER COMMENTS - STEP 2
STEP 2
1 General Cover Change issue purpose to FOR APPROVAL. Noted No comments. C
2 General Welder lists and certificate Please attach certified welder name list and his certificate. Attached No comments. C
3 General WPS and PQR Please attach the WPS and PQR as per original format. Noted No comments. C
C