THOROUGH EXAMINATION REPORT

This report complies with the requirements of The Lifting Operations and Lifting Equipment Regulations 1998

Report No. : Color Code : Job No. : Date of Report :

RPT/SPT/LMG/2020/III/000/001 - 13-Jan-2021

Company for whom examination was made: Location of where examination took place:
PT. INDO KAYA ENERGI IKE Workshop
Patria Park Office RK16 D.I Pandjaitan Kavling 5-7 Jl. Lanbau Kampung Lio Baru, Citereup - Bogor
Jakarta Timur

*Key
A B C D E F ND SNCR NF SC
See Non-
Exceptional Other written
Installation 6 Monthly 12 Monthly 5 Yearly No defect conformance Not found Scrapped
circumstance scheme
report

Serial Number Description SWL

IKE-SC21-01 Bolt Type Anchor Shackle 4,75 tonne

IKE-SC21-02
IKE-SC21-03 Manufacturer : Crosby
IKE-SC21-04 Size : 3/4"

Thorough Examination Examination

Status* Safe to use
Reason for* Date of last Date of this Date of next Scope Findings

B - 8-Jan-2021 8-Jul-2021 VN None ND Yes

Examined in accordance : BS EN 13889 + A1

Name of person who carried out the examination : Rahmad Wahyu Sentosa
Position & Qualification of person who carried out the examination : Inspector - LEEA Diploma Registered: 028696

Signed :

Authenticating by : Nur Falah Kamil

Position : Senior Inspector

Signed :

Form No. F-OPR-SPT-12.7.17 Rev.1

PT. Survey Inspeksi Audit Pratama Tekindo (SIAPTEK)
Website: www.siaptek.com | Email: info@siaptek.com Page 1 of 1
Base: Lamongan, Surabaya, Jakarta, Sorong, Balikpapan, Batam
 SHACKLE CHECKLIST

Report No. : Color Code : Unit No. : Date of Report :

RPT/SPT/LMG/2020/III/000/001 - IKE-SC21-01 13-Jan-2021

Requires
Area Checked Satisfactory Not applicable Comments
attention
Document information
Certificate of Conformity (CoC) ✘

Previous Inspection Report ✘

Other (specify)
Physical markings
SWL ✘

Identification number(s) ✘

CE Mark ✘

Manufacturer Mark ✘

Visual examination - Body

Nicks / cracks / gouges ✘

Wear / distortion / stretch ✘

Corrosion ✘

Thread wear / damage ✘

Measurement ✘

Visual examination - Pin

Nicks / cracks / gouges ✘

Wear / distortion / stretch ✘

Corrosion ✘

Thread wear / damage ✘

Measurement ✘

Form No. F-OPR-SPT-12.7.24

PT. Survey Inspeksi Audit Pratama Tekindo (SIAPTEK)
Website: www.siaptek.com | Email: info@siaptek.com Page 1 of 1
Base: Lamongan, Surabaya, Jakarta, Sorong, Balikpapan, Batam
 PHOTOGRAPHIC OF EXAMINATION

Report No. : Color Code : Unit No. : Date of Report :

RPT/SPT/LMG/2020/III/000/001 - IKE-SC21-01 13-Jan-2021

Fig : View of Shcakle

Form No. F-OPR-SPT-12.7.42 Rev 0

PT. Survey Inspeksi Audit Pratama Tekindo (SIAPTEK)
Website: www.siaptek.com | Email: info@siaptek.com Page 1 of 1
Base: Lamongan, Surabaya, Jakarta, Sorong, Balikpapan, Batam
 Doc ID: SPT-OP-NDT-002
INTERGRATED TECHNICAL CONSULTANCY AND SERVICES
Revision No: 03

MAGNETIC PARTICLE INSPECTION REPORT Effective Date: 01-08-2019

Client : PT. INDO KAYA ENERGI Report No. : RPT/NDT/SPT/LMG/2020/X/401/003A

Client Address : Patria Park Office RK16 D.I Pandjaitan Kavling 5-7Procedure No. : INSP-SPT-02
Jakarta Timur

Location of Inspection : IKE Workshop Refer to PO :

Jl. Lanbau Kampung Lio Baru, Citereup - Bogor
Date of Inspection : 8-Jan-2021 Date of Last - : -
Thorough Inspection
Drawing No. : - Welding process : -
Material spec. : Ferromagnetic Test Specification : BS EN ISO 17638 : 2016
Light type : Natural Light intensity : -
Contrast paint : Magnaflux WCP-2 Particle Ink : Magnaflux Ink 7HF
Batch no. of Contrast Paint : 2006261 Batch no. Particle Ink : 200609
MPI Unit : ✘
Yoke Prods Coil Serial No. : 12909
Type of current : ✘
AC Permanent HWDC / HWAC Others ( )
Type of inspection : Dry ✘
Wet Fluorescent ✘
Non Fluorescent
Method examination : ✘
Continuous Residual
Surface condition : As welded ✘
As forged As rolled Others (As Cast)
Surface preparation : Grinding Machining Blasting ✘
Brushing
Time of inspection : After welding After hydrotest After PWHT ✘
Others (After Clean)
Scope of inspection : ✘ Base metal Edge prep Back chipping
Weld part Repair weld Others ( )

Type of
Description Area Inspected Thickness (mm) Accepted Rejected Remarks
discontinuity

4 Leg Wire Rope Sling ID No:

All Body - P - - -
FJ 19D 1514

Pictures:

Acceptance Criteria : BS EN 10228-1: 2016, BS EN 1677-4: 2000 + A1: 2008

Notes : √ : Ok , X : Not Ok , N/A : Not Applicable
Result : No relevant indication found during inspection
Inspector Name & Signature : Rahmad Wahyu Sentosa Inspector Certification : NDT Level II

Date : 13-Jan-2021 Report to be kept 3 years minimum

Except for cases of proven negligence of fraud by SIAPTEK, the Client agrees to hold harmless and indemnify SIAPTEK and its inspectors, technicians, officers, employees, agents or subcontractors against all claims (actual or threatened) by them and by any third party for loss, damage or expense of
whatsoever nature including all legal expenses and related costs and however arising relating to the performance, purported performance or non-performance of the services or out of or in connection with Client’s product, process or service the subject of the certification including, without limitation,
product liability claims. The total liability of SIAPTEK to the Client in respect of any claims for loss, damage or expense of any nature and howsoever arising shall be limited, in respect of any one event or series of connected events, to an amount equal to US$ 1,000 (excluding Value Added Tax thereon).

Registered :
 www.siaptek.com
E-mail:info@siaptek.com