INSPECTION AND TEST PLAN Hal 1 dari 6

BARTON CHART RECORDER Document No.

202E Rev.

NO KONTRAK : 155/KKG/PEP-CMB/PWM/TQ-02/0 6-22

NAMA PROYEK : PEMBANGUNAN FASILITAS PENDUKUNG SISTEM GAS COMRESSOR
DI NFG CEMARA BARAT FIELDPERTAMINA EP ASSET 3

BY CHECK APPR. CHECKED APPROVED

REV DATE DESCRIPTION
KONSORSIUM KME-GDES PERTAMINA EP
 INSPECTION AND TEST Document No.
PLAN
BARTON CHART RECORDER Rev. :0
202E Page : 2 dari 6

DAFTAR ISI

1. HALAMAN COVER ................................................................................................................ 1

2. DAFTAR ISI ...........................................................................................................................2
3. INSPECTION AND TEST PLAN FOR BARTON CHART RECORDER 202E ...................... 3

THIS DOCUMENT AND ANY DATA AND INFORMATION CONTAINED HERE IN ARE CONFIDENTIAL AND THE PROPERTY OF PT
PERTAMINA EP. DATA OR INFORMATION SHALL BE NOT DISCLOSED TO OTHERS OR REPRODUCED IN ANY MANNER OR USED FOR
ANY PURPOSE WHATSOEVER, EXCEPT WITH THE PRIOR WRITTEN PERMISSION OF PT PERTAMINA EP.
 I NSPECTI ON TEST PLAN FOR BARTON CHART RECORDER 202E
Client : PERTAMINA EP Job No. :

Project Title : PEMBANGUNAN FASILITAS PENDUKUNG SISTEM GAS COMRESSOR DI NFG CEMARA BARAT FIELD PERTAMINA EP ASSET 3
Supplier : PT. Prambanan Sarana Sejati Purchaser : Konsorsium PT. Karya Mas Energi - PT Gerindo Dwidaya Energi Solusi
Location : Bekasi Selatan - Bekasi Date Submission :
Purchase Order No. : 155/KKG/PEP-CMB/PWM/TQ-02/0 6-22 TNS Document No. :
Description : Barton Chart Recorder 202 E (3 Pen) Approved By :
Revision No. :

Controlling Document PT. Prambanan Sarana Sejati PT. Karya Mas Energi- PT Gerindo Pertamina EP
Include Dwidaya Energi Solusi
Document
Activity No. Activity Description Acceptance Criteria Certifying / Verifying Document
Std. Spec. or Drg. Reference in MDR?
Y/N Activity Signature Activity Signature Activity Signature Activity Signature
etc. Document

1 Purchase Order Purchase Order Factory Order acknowledgement N R - -

2 WFC Calculation Approved WFC Approved WFC Approved Y R R&M R

3 Barton Chart Recorder Calibration Test Barton Chart Specification Calibration Certificate Y R R&M R

4 Hydrotest ASME B31.3 Hydrotest Certificate Y R R&M W/H

5 Material Test Report EN 10204 3.1 Material Certificate Y R R&M R
Manufacture Standard
6 Verification COC COC Certificate Y R R&M R
Functional Test & Verification Reading for
Functional Test, Visual & Dimension Check
7 Customer Acceptance for Functional Test DP,P and T Barton Chart Recorder Y W W W/H
at Vendor Workshop
Visual & Check Dimension
8 Packing and Delivery Manufacture Standard Packing, Handling & Storage Procedure Y R M R

9 Final & Release Note IRN & MDR Inspection Document Y R M R

(1)
Key to activity codes : H = Hold points D = Submission Documents and (2) to be completed by Supplier before submission to Purchaser
(3)
W = Witness RI : Random Inspection and (4) to be completed in accordance with the requirements of Requisition / Purchase Order /
M = Monitoring Surveillance Plan by Supplier. Purchaser will add / state its additional involvement
I = Information ' through review, audit, monitoring, witness, hold or certification point.
R = Review documentation (Note : Engagement for 3rd party inspection shall be under clients obligation)
Notes : 1, For 'H' and 'W' stages, Supplier shall notify Purchaser ten (10) days in advance of stage being reached. MDR : Manufacturer's Data Reports
2, Equipment shall not be released until acceptance of all stages by Purchaser.

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 I NSPECTI ON TEST PLAN
Client : PERTAMINA EP Job No. :

Project Title : PEMBANGUNAN FASILITAS PENDUKUNG SISTEM GAS COMPRESSOR DI NFG CEMARA BARAT FIELDPERTAMINA EP ASSET 3
Supplier : PT. Prambanan Sarana Sejati Purchaser : Konsorsium PT. Karya Mas Energi - PT Gerindo Dwidaya Energi Solusi
Location : Bekasi Selatan - Bekasi Date Submission :
Purchase Order No. : 155/KKG/PEP-CMB/PWM/TQ-02/0 6-22 TNS Document No. :
Description : Barton Chart Recorder 202 E (3 Pen) Approved By :
Revision No. :

INSTRUCTIONS

The Inspection Test Plan shall include the following information which may be presented in this typical format or on the Supplier's Standard Format.

Activity Number Activity number shall be allocated to each activity within the process which affects quality.

Activity Description Brief description of each activity to be performed during execution of Contract/Purchase Order to be provided in this column.

Controlling Documents The precise controlling document no. shall be specified (e.g. Contract Documents, Specifications, Codes and Standards, Controlling Procedures/
(Basis of Activity) Instructions, etc.)

Acceptance Criteria This shall show the criteria whether Statutory, Codes & Standards, Purchaser's Specification against which an inspection and/or test shall be measured.

Certifying / Verifying Document This shall identify those documents/records, produced as an evidence of completion of an activity in compliance with or otherwise to the specified
controlling procedures.

NOTE :
The Supplier's representative shall sign against each activity to indicate satisfactory completion of that activity. The Purchaser's representative / verifying body /
certifying body shall review and sign the applicable activities Inspected/Tested/Witnessed.

The Supplier shall ensure that all Subvendors are furnished with all relevant project procedures and specifications, and relevant codes and standards are complied with.

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