SSP Doc no.

:
FIELD INSPECTION & TEST PLAN FOR Date :
CONCRETE WORKS & GABION Revision No : 0
(MASS and NORMAL POUR)

Project: LONTAR EXTENSION COAL FIRED POWER PLANT 1X 315 MW

Owner :
Area of Work : CWP Zone 4 C
Work : Concrete Pouring (Mass & Normal / Standard Pour)

REFERENCE DOCUMENT / CODE / INSPECTION RESPONSIBILITY

NO. INSPECTION OR TEST ITEM STANDARD ACCEPTANCE CRITERIA VERIFYING DOCUMENT CONSORTIUM OWNER
REMARKS

I DOCUMENT REVIEW

1.1] Scope of Work (SOW) Contract Documents Latest Amendment Daily / Weekly Report R R
1.2] Technical Requirements / Specification Contract Documents Latest Amendment Daily / Weekly Report R R
1.3] Engineering & Construction Drawings SOW, ASTM Stds. & ACI Code Approved by PLN Daily / Weekly Report R R
SOW, Eng'g & Construction Drawings Approved by Consortium/PLN Daily / Weekly Report R R

II VERIFICATION of MATERIAL, EQUIPT.

and PERSONNEL

2.1] Material
a) Concrete Mix Technical Spec. & Engineering Design Per Mix Design & Class * Trial/Design Mix Report I, A A, H * PLN Hold Point
b) Cement Technical Spec., ASTM C150 & SNI Type V - Sulfate Resistant Material Receipt Report (MRR) / V, R R
Manufacture Test Report (MFR)
c) Sand / Fine Aggregate Spec., ASTM C33, C289, C295 & SNI Natural & Graded Material Receipt Report (MRR) R R
d) Gravel / Coarse Aggregate Spec., ASTM C33, C289, C295 & SNI Crushed Stone & Graded Material Receipt Report (MRR) R R
e) Water Spec., ASTM C94 & SNI Fresh & Clean Water Water Analysis Report R R
f) Admixtures Spec., ASTM C260, C309, C494 & SNI Approved by PLN & w/MSDS Material Receipt Report (MRR) / V, R A, H* * PLN Hold Point
g) Anchor Bolts/Frames & Structural Tech. Spec., Construction Dwgs. and Comply w/ Tech. Spec. and
MRR & Daily Report I, A V, R
Members / Embeds Material / Mill Certificates Construction Dwgs.
Spec., PB-0201-76, AASHTO T -27 -82,
h) Gravel fill / Coars Agregat Screening Graded Material Receipt Report (MRR) R R
ASTM C -136 -04
i) Gabion
- Broken Rock Spec., ASTM C -136 -04 Graded Material Receipt Report (MRR) R R
- PVC COAT Spec., SNI 03 - 3046 - 1992 Approved by PLN Material Receipt Report (MRR) V, R A, H*
k) Reinforcing Bars Tech Spec., ASTM A615 & SNI With Mill Test Report / Certs. Material Receipt Report (MRR) I, A V, R
New, Water Proof, Resin Bonded,
l) Forms, Plywood, Lumber & Form Oil Technical Specification & SNI Straight, Uniform Witdh & Free of Material Receipt Report (MRR) V R
Defects
Technical Spec., Product Info Sheet and Comply w/ Technical Specification
m) EJ* Fillers & Bonding Agents (if required) MRR & Daily Report I, A V, R * EJ = Expansion Joint
MSDS and MSDS
n) Construction Consumables Tech. Spec. & Standard Practice Enough Quantity Daily Report V R
 REFERENCE DOCUMENT / CODE / INSPECTION RESPONSIBILITY
NO. INSPECTION OR TEST ITEM STANDARD ACCEPTANCE CRITERIA VERIFYING DOCUMENT CONSORTIUM OWNER
REMARKS
2.2] Equipment
a) Survey Equipment Equipt. Operation & Calibration Manual Site Calibrated Before Use Site Calibration & Survey Rept. V, R R
b) Lifting Equipment Equipt. Mob. & Maintenance Report HSE Certificate Daily & HSE Inspection Report V, R R
c) Concrete Pump Equipt. Manual & Maintenance Report Good & Operable Condition Daily & HSE Inspection Report V, R R
d) Mobile Concrete Mixer Equipt. Manual & Maintenance Report Good & Operable Condition Daily & HSE Inspection Report R R
e) Concrete Vibrator Mobilization & HSE Inspection Report Good & Operable Condition Daily & HSE Inspection Report R R
f) Reinforcing Bar Cutter Mobilization & HSE Inspection Report Good Condition Daily & HSE Inspection Report R R
g) Reinforcing Bar Bender Mobilization & HSE Inspection Report Good Condition Daily & HSE Inspection Report R R
h) Exothermal / Cad / Thermit Welder PO/Instruction Manual/Delivery Rep. Mock Up Completed* Daily Report I, V V, R *Field Simulation/M-Up
i) Various Work Tools and Aids HSE Inspection Report Enough Qty. & Good Condition Daily / Weekly Report R R

2.3] Supervsion & Personnel

a) Coordinator / Supervisor / Leader Manpower Plan & Mob. Report Qualified and Experienced Training & Employer Certs. R R
b) Surveyor / Survey Team Manpower Plan & Mob. Report Qualified and Experienced Training & Employer Certs R R
c) Skilled Workers Manpower Plan & Mob. Report Qualified and Experienced Training & Employer Certs.
d) Labourer / Unskilled Workers Mobilization Report Experienced Employer Certification

III CONCRETE WORKS

3.1 Rebar Works

a) Storage of Reinforcing Bars at site Mat'l. Storage & Preservation Procedure Clean Area Daily / Weekly Report V R
Material Receipt Report (MRR) & * Comply w/ Rebar Schedule
b) Type and Diameter Construction & Shop Drawings Comply w/Shop Dwg.* I I
Mill Certs (As needed) & Arrangement Dwg.

c) Cleanliness, Cut Length & Bending Shop Drawings Comply w/Shop Dwg. QC Inspection Record I I Concrete Pour Permit
d) Placement & Setting of Embedments Construction Drawing / Survey Report Comply w/Construction Dwg. QC Inspection Record I I Concrete Pour Permit
e) Arrangement of Bars & Rigidity of Construction & Shop Drawings Per Arrrangement Drawing QC Inspection Record I I Concrete Pour Permit
Rebar Cage Assembly
f) Concentricity of Placed Rebar Assembly Construction & Shop Drawings Per Arrrangement Drawing QC Inspection Record V I
g) Lines & Grade of Set Rebar Assembly Basic Survey Report & Drawings True to Lines and Grade Survey Report R R
 REFERENCE DOCUMENT / CODE / INSPECTION RESPONSIBILITY
NO. INSPECTION OR TEST ITEM STANDARD ACCEPTANCE CRITERIA VERIFYING DOCUMENT CONSORTIUM OWNER
REMARKS
3.3 Form Works
a) Storage of Formworks Material Mat'l. Storage & Preservation Procedure Clean & Dry Area Daily / Weekly Report V R
b) Cutting to Shape & Size of Form Wall Rebar Schedule/Arrangement Dwg. Per Construction/Shop Dwgs. Daily / Weekly Report R R
c) Rigidity & Squareness of Assembled Construction Dwgs/Method Statement Per Construction/Shop Dwgs. QC Inspection Report V, R R
Form Works
d) Oiling of Form Walls & Cleanliness of Tech.Spec. & Method Statement Comply w/ Work Method Concrete Pour Permit V I
Base of Part to be Concreted Statement (WMS)
e) Centerline Coordinates & Elevation of Basic Survey Report & Drawings True to Lines and Grade Survey Report V I
Assembled Form Works.
f) Construction Joints Construction Drawing, WMS and Comply w/Dwgs., WMS and Daily Report I, V I
Technical Requirements provided w/bonding agent

3.4 Concrete Pouring

a) Concrete Pour Permit Quality Control Plan & Procedure Approved Prior to Concrete Pour Request For Inspection (RFI) V, A A, H PLN Hold Point
b) Ready or Site Mix Concrete Trial/Design Mix and Lab. Test Report Comply w/Required Class Delivery Slip/Ticket & Daily Rept. V W
c) Concrete Conveyance / Placement or Tech. Requirement & WMS Comply w/Method Statement and Daily Report I, V, R I, V (3)
Pouring Aids; Direct Pour or Tremie or Chutes Field Condition-as necessary.
or Concrete Pump or in combination as
needed or necessary. (3)
d) Concrete Mix (CM) Slump & Sampling for Comply w/Tech. Spec. & Trial Concrete Pour Permit & Record
Tech. Spec. & Trial Mix Lab. Test Report W W
Laboratory Test Mix Field & Lab Test Results and Lab Test Report
e) Workability, Consolidation * & Setting Tech. Spec., SNI & Method Statement Comply w/Tech. Spec. Concrete Pour Record (CPR) W W *Mechanical Vibrator
of Poured Concrete Mix
ACI 304R, 305R, 308R & 309R & Part 4, Section 4.5, Sub-
f) Concrete Mix Temperature Control During Section

Section 4.5, Sub-Section 4.5.6, Clause 4.5.6.1,

Pour (Hot Weather Pour for Mass Concrete Works).
f.1] Temperature of Mix During Pour and Sub-Clause 4.5.6.1.13 and WMS ≤ 32 Degrees C Daily Report and CPR I W
f.2] Temperature Differnce, Bottom (lower) vs ≤ 20 Degrees C Daily Report and CPR I W
Top (Upper) part of concrete in place
g) Construction Joints W W
h) Leveling & Finishing Method Statement & Std. Practice Comply w/Dwg. & WMS Concrete Pour Record W W
i) Protection from Rain & Curing (3) Method Statement & Std. Practice Per Quality Plan (QP) & WMS Daily Report I, V I, V (3)
j) Formworks Removal Method Statement & Std. Practice Comply QP and WMS Daily Report I I, V (3)
k) As Built Survey; Center Line Coordinates, Basic Survey Drawings & Report True to Lines and Grade As Built Survey Report V, R R
& Elevation & Battery Limits of Concrete
or Concreted Part

IV GABION WORK
- PVC COAT Method Statement & Std. Practice Comply w/Dwg. & WMS Request For Inspection (RFI) W W
 REFERENCE DOCUMENT / CODE / INSPECTION RESPONSIBILITY
NO. INSPECTION OR TEST ITEM STANDARD ACCEPTANCE CRITERIA VERIFYING DOCUMENT CONSORTIUM OWNER
REMARKS
V QC DOCUMENTS & REPORTS

5.1 Material Certificates Manufacturer's Final Report (MFR) Reviewed & Found Complete V, R R
5.2 Laboratory Test Reports for Materials* Tech. Spec. & RFI All Test Reported / Complete V, R R
5.3 As Built Survey Report / Drawings Tech. Spec. & Method Statement Comply w/QP and WMS Final Document Handover Report V, R R
5.4 Hoilday & Pneumatic/Service Test Reports Tech. Spec. & Method Statement Signed /Approved by PLN V, R V, R
5.5 Final Inspection Report Tech. Spec. & Quality Plan Signed/Approved by PLN V, A R, A

Legend and Definition: R = Review I = Inspect W = Witness V = Verify A = Accept / Approve H = Hold Point
HOLD POINT = Specific Work Item or Activity Inspected by CLIENT / CLIENT Representative or Test and Test Results on this Same
Work Shall be Accepted / Approved by Client or Client Representative Before the Immediately Succeeding Work or
Activity May Be Started or May Proceed.

NOTICE OF AUTHORIZATION TO COMMENCE

The Undersigned hereby agree and approve site implementation of this Inspection and Test Plan (ITP) for the WORKS.

CONSORTIUM OWNER

NAME: DATE: ___________ NAME: DATE: _________ NAME: DATE: _____________