PT HASTAKARYA TUNGGAL MANDIRI
MATERIAL INSPECTION REPORT (STEEL) FORM
Project Name : Fabrication & Installation Plateform Walkway
Contractor : PT Hastakarya TM Serial No : MIR/LCTN-HTM/001/12/2019
Date : 06 Dec 2019
Delivery of Steel Checklist Reference : RFQ-6000127225
Drawing Refference : Contract No : 4501258409
Disposition
Inspection Date
Description of Activities Accept Reject Hold
Delivery Note □ □ □ December 6, 2019
Mill Certificate □ □ □ December 6, 2019
Heat Number □ □ □ December 6, 2019
Quantity Control Certificate of Supplier □ □ □ December 6, 2019
Material Specification □ □ □ December 6, 2019
Remarks : Description of Steel
1. H-Beam 150x150x6mtr
2. Siku 50x50x5x6mtr
3. Siku 65x65x6x6mtr
4. Unp 100x50x6mtr
5. Grating 1"x3/16x3x20
6. Plat Hitam 10mmx4x8
Comments : (Consultants)
No Description of Material Witness Materials Remarks
1 H-Beam 150x150x6mtr
2 Grating 1"x3/16"x3x20
3 Plat hitam 10mm
IR-LCTN/HTM-001/12-2019
4 Siku 50x50x5x6mtr
5 Siku 65x65x6x6mtr
6 Unp 100x50x6mtr
Checked By: Inspected By: Witnessed By:
Name : Juni Kusdianto Name : Hidayat Name : Gema Arias
Company : PT Hastakarya TM Company : PT LCTN Company : PT LCTN
Position Contractor Representative Position Q.C. Inspector Position Project Engineer
Date : Friday, 06-12-2019 Date : Friday, 06-12-2019 Date : Friday, 06-12-2019
Sign : Sign : Sign :
IR-LCTN/HTM-001/12-2019