INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL

TIME SHEET
VESSEL : BG.GABRIELLA II
PORT : KAMPUNG BARU
CARGO : CRUDE PALM OIL
QUANTITY : MT
SHIPPER : PT.KUTAI REFINERY NUSANTARA
BUYER : CV.JAYA SEMESTA

DATE

*ARRIVED AT ANCHORAGE/PILOT STATION : JANUARY - - 2023

*NOTICE OF READINESS TENDERED : JANUARY - - 2023
*PILOT BOARDED :
ALL FAST AT JETTY JANUARY - - 2023
GANGWAY DOWN :
FREE PRATIQUE :
SURVEYOR ON BOARD : JANUARY - - 2023
COMM.TANK INSPECTION : JANUARY - - 2023
COMP.TANK INSPECTION/GAUGING : JANUARY - - 2023
NOTICE OF READINESS ACCEPTED : JANUARY - - 2023
CARGO HOSE CONNECTED : JANUARY - - 2023
COMMENCED LOADING JANUARY - - 2023
COMPLETED LOADING JANUARY - - 2023
CARGO HOSE DISCONECTED : JANUARY - - 2023
COMP.GAUGING/CALC./TANK INSPECTION : JANUARY - - 2023
VESSEL UNBERTEHED/SAILED : JANUARY - - 2023

*AS ADVISED BY VESSEL'S CHIEF OFFICER

REMARKS

( WAHYU NURDIANTO ) (………………………..) ( …............................)

ATTENDING SURVEYOR SHIPPER CHIEF OFFICER

CWM SURVEY & INSPECTION

Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 D-929

TIME SHEET

HOURS

// : LT
// : LT

// : LT

// : LT
// : LT
// : LT
// : LT
// : LT
// : LT
// : LT
// : LT
// : LT
// : LT

( …............................)
CHIEF OFFICER

CWM SURVEY & INSPECTION

RA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
hone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL

DATE : JANUARY - - 2023

VESSEL : BG.GABRIELLA II
PORT : KAMPUNG BARU
VOYAGE NO :

TO WHOM IT MAY CONCERN

Dear Sir,

NOTICE OF DISCREPANCY
We the andersigned, have been appointed as surveyors by PT. SURYA BUANA INSPECTINDO
Messrs CV.JAYA SEMESTA
and we have to draw your attention to the discrepancy in quantity at present
ascertained as :
Cargo : CRUDE PALM OIL
Stowage : SHIPTANK NO.
Bill of Loading qty - mt (BL) : M/Tons
Vsl's of Loading qty - mt (VL) : M/Tons
Difference : M/Tons
Percentage : %

We hereby lodge a this notice to vessel/ vessel's owner/agents and/or carriers on

behalf of our principal for the above discrepancy and reserve the right to refer to
this matter at a letter date.

Please acknowledge receipt, thank you.

Yours faithfully, Acknowledged receipt by

( WAHYU NURDIANTO ) (………………………..) ( …............................)

Attending Surveyor Shipper Chief Officer

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL

RECAPITULATION
OF WEIGHLIST

VESSEL : BG.GABRIELLA II
CARGO / QUANTITY : CRUDE PALM OIL /± MT
SHIPPER : PT.KUTAI REFINERY NUSANTARA
BUYER : CV.JAYA SEMESTA
PLACE AND DATE : KAMPUNG BARU UP TO JANUARY - - 2023

WEIGHT ( KGS )
NO DATE TRUCK
GROSS TARRE NETTO

TOTAL

ACKNOWLEDGED BY, SURVEYOR

(………………..…………..) ( WAHYU NURDIANTO )

SHIPER
ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL

VESSEL'S TANK GAUGING REPORT

VESSEL : BG.GABRIELLA II DATE : JANUARY - - 2023

CARGO : CRUDE PALM OIL PORT : KAMPUNG BARU

DRAFT BEFORE FWD : M AFTA : M LIST:

DRAFT AFTER FWD : M AFTA : M LIST:

VESSEL'S CORR.DIP/ TEMP DENSITY VOLUME METRIC

CARGO
TANK NO ULLAGE / SOUNDING °C kg/ltr CU.MTR TONS
CRUDE PALM OIL

SF AFTER LOADING :

BILL OF LOADING :

DIFFERENCE :

PRECETANCE : %

NOTE : The vessel tanks were guaged cojointly with the chief
officer and was calculated according to vessel's caliberation
tables provided

( WAHYU NURDIANTO ) (………………………..) ( …............................)

Attending Surveyor Shipper Chief officer

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 CERTIFICATE OF CLEANLINESS, TIGHTNESS AND FITNESS
OF SHIP'S TANK AND CONNECTING PIPELINESS / HOSES

VESSEL : BG.GABRIELLA II
VOYAGE NO :
DATE OF LOADING : JANUARY - - 2023
PORT OF LOADING : KAMPUNG BARU
PORT OF DISCH : JETTY

### THE UNDERSIGNED, CERTIFY THAT THE FOLLOWING CARGO TANK ( S )

PORT : 1P,2P,3P,4P,5P,6P,7P
CENTER :-
STARBOARD : 1S,2S,3S,4S,5S,6S,7S

TO THE BEST OF OUR KNOWLEDGED HAVE TIGHT BULKHEADS, PIPELINES, HOSES

AND VALVES ARE IN CLEAN & FIT CONDITION TO RECEIVE THE NOMINATED
CARGO OF :

CRUDE PALM OIL

### EVIDENCING THAT TANKS, HEATING COILS AND APPLIANCES USED FOR LOADING
AND DISCHARGING CARGO DO NOT CONTAIN COPPER OR COPPER ALLOYS.

TANK COATING : MILD STEEL

HEATING COIL : N.I.L
CHIEF OFFICER NAME : ( …............................)

SIGNATURE AND SHIP'S STAMP

( …............................)
CHIEF OFFICER
TO WHOM IT MAY CONCERN

VESSEL : BG.GABRIELLA II

BERTH :

CARGO : CRUDE PALM OIL

SHIPPER : PT.KUTAI REFINERY NUSANTARA

BUYER : CV.JAYA SEMESTA

DATE : JANUARY - - 2023

" CERTIFICATE OF LAST THREE CARGOES "

This is certify that the last three previous cargoes carried in the nominated ship's tank to load the
above mentioned cargo are as follows :

Ship's Tank : LAST CARGO SECOND LAST CARGO THIRD LAST CARGO

Above particulars are advised/certify by the ship's Master/Chief Officer

The vessel Master further certify that the tanks have not contained any leaded petroleum or any other
leaded product ( CLEAN AND UNLEADED ) on at least the three last cargo voyages and heating coils, lines.
Pump of fitting used do not contain copper or copper alloy.

Yours faithfully Ackhnowledge receipt

( WAHYU NURDIANTO ) ( …............................)

SURVEYOR Chief Officers
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
MEMBER OF
The assosiation of
independent survetors indonesia

SAMPLING REPORT

Vessel Name : BG.GABRIELLA II

Shipper : PT.KUTAI REFINERY NUSANTARA
Notify Party : CV.JAYA SEMESTA
Cargo : CRUDE PALM OIL
Nominated Quantity : MT
Place of Sampling : SHORE TANK NO.
Date of Sampling : JANUARY - - 2023
Sampling Method : AVERAGE
Port of Loading : KAMPUNG BARU
Port of Discharge : JETTY PT.KRN

Samples were taken, labeled and sealed by surveyor and witnessed by representative of
CV.JAYA SEMESTA

Sampling distribution:

NUMBER OF SAMPLES SEAL NOS DISTRIBUTION

1 BOTTLE As per shipper
1 BOTTLE As per Buyer
1 BOTTLE as per Surveyor PT. Surya Buana Inspectindo
1 BOTTLE as per Laboratorium

Acknowledged by, Acknowledged by, Made by,

( …............................) ( WAHYU NURDIANTO )

Chief Officer Shipper Representative Inspector / Surveyor

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
MEMBER OF
The assosiation of
independent survetors indonesia
SAMPLING REPORT

Vessel Name : BG.GABRIELLA II

Shipper : PT.KUTAI REFINERY NUSANTARA
Notify Party : CV.JAYA SEMESTA
Cargo : CRUDE PALM OIL
Nominated Quantity : MT
Place of Sampling : SHIP'S TANK NO.
Date of Sampling : JANUARY - - 2023
Sampling Method : COMPOSITE
Port of Loading : KAMPUNG BARU
Port of Discharge : JETTY PT.KRN

Samples were taken, labeled and sealed by surveyor and witnessed by representative of
CV.JAYA SEMESTA

Sampling distribution:

NUMBER OF SAMPLES SEAL NOS DISTRIBUTION

1 BOTTLE As per shipper
1 BOTTLE As per Buyer
1 BOTTLE as per Surveyor PT. Surya Buana Inspectindo
1 BOTTLE as per Laboratorium

Acknowledged by, Acknowledged by, Made by,

( …............................) ( WAHYU NURDIANTO )

Chief Officer Shipper Representative Inspector / Surveyor

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
SAMPLING REPORT
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
MEMBER OF
The assosiation of
independent survetors indonesia

BERITA ACARA
HASIL ANALISA LABOLATORIUM
(BEFORE LOADING )

NAMA KAPAL : BG.GABRIELLA II

JENIS MUATAN : CRUDE PALM OIL
NOMINASI MUAT : MT
PENGIRIM : PT.KUTAI REFINERY NUSANTARA
PEMBELI : CV.JAYA SEMESTA
LABOLATORIUM : PT.KUTAI REFINERY NUSANTARA
TANGGAL : JANUARY - - 2023

Dengan ini kami PT.SURYA BUANA INSPECTINDO, yang ditunjuk oleh

CV.JAYA SEMESTA untuk melaksanakan survey pengawasan pemuatan
CRUDE PALM OIL dengan nominasi quantity MT
atas kapal/tongkang BG.GABRIELLA II
Berkenan dengan perihal tersebut diatas, kami melaporkan hasil analisa yang telah
dilakukan oleh petugas Analisa labolatorium pihak Pengirim / Penerima dengan hasil
analisa sebagai berikut :

STORAGE NO STORAGE NO
PARAMETER
AVERAGE AVERAGE
FFA
Moisture
DIRT
DOBI
Kesimpulan:

Demikian Berita Acara ini dibuat untuk dapat dipergunakan sebagaimana mestinya.

PT.KUTAI REFINERY NUSANTARA PT.SURYA BUANA INSPECTINDO

(………………………..) ( WAHYU NURDIANTO )

Shipper Surveyor

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
MEMBER OF
The assosiation of
independent survetors indonesia

BERITA ACARA PEMERIKSAAN PALKA

NAMA KAPAL : BG.GABRIELLA II

MUATAN/QUANTITY : CRUDE PALM OIL
PENGIRIM MUATAN : PT.KUTAI REFINERY NUSANTARA
PEMBELI MUATAN : CV.JAYA SEMESTA
PELABUHAN MUAT : KAMPUNG BARU
PELABUHAN BONGKAR : JETTY

Pada hari ini Senin Tanggal JANUARY - - 2023 kami selaku surveyor dari
PT.SURYA BUANA INSPECTINDO , yang ditunjuk oleh CV.JAYA SEMESTA
Dengan ini menerangkan bahwa kami telah melakukan pemeriksaan pada tiap tangki pemuatan
kapal sebelum dilakukan pemuatan diatas kapal BG.GABRIELLA II
dari hasil pemeriksaan ruang muat tangki (inspection ) yang kami lakukan mulai pukul
……….. s/d…………LT, Kami selaku independen surveyor berpendapat bahwa
pada tiap tiap tangki kapal tersebut SIAP dan LAYAK untuk melakukan proses pemuatan
CRUDE PALM OIL
Adapun posisi Tangki ballast terletak didekat tangki no ……….……dibagian BELAKANG
dalam kondisi Terisi air tawar dengan quantity +/- TON

Dibuat Oleh Diketahui Oleh

( WAHYU NURDIANTO ) (………………………..) ( …............................)

Surveyor Shipper Chief Officer

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
MEMBER OF
The assosiation of
independent survetors indonesia

REPORT
OF
SEALING

VESSEL : BG.GABRIELLA II
CARGO : CRUDE PALM OIL
START LOADING : JANUARY - - 2023 // LT
COMPLETED LOADING : JANUARY - - 2023 // LT
SHIPPER : PT.KUTAI REFINERY NUSANTARA

This is to certify that we undersigned surveyor of PT. Surya Buana Inspectindo Jakarta did at
request of Messrs CV.JAYA SEMESTA
to conduct the loading supervision CRUDE PALM OIL
to be loaded on board your vessel BG.GABRIELLA II
berthed at wharf KAMPUNG BARU
Herewith, we certify that before departure from loading port, vessel BG.GABRIELLA II
all of compartments, which have connection to cargo were sealed, the detail as follows:

1 MANHOLE : PCS up/to

2 SOUNDING PIPE : PCS up/to

3 VALVE : PCS up/to

4 IN / OUT CARGO LINE : PCS up/to

5 PUMP ROOM : PCS up/to

6 COFERDAM / FILTER : PCS up/to

SOUNDING TAPE,
7 : PCS up/to
TABLE, TEMPERATURE
8 DOCUMENT : PCS up/to

TOTAL : PCS
All seals were set well / intact

Made by, Acknowledged by, Acknowledged by,

( WAHYU NURDIANTO ) (………………………..) ( …............................)

Inspector / Surveyor Shipper Representative Chief Officer

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
MEMBER OF
The assosiation of
independent survetors indonesia

SURAT TUGAS
ASSIGMENT LETTER

PT. Surya Buana Inpectindo sebagai PT. Surya Buana Inpectindo as the
representative dari CVM Survey & Inpection respensentative of CWN Survey & Inspection
dengan ini menungaskan kepada karyawan assign the under mentioned staff (s)
tersebut dibawah ini :

Nama/ Name : SANTO WIDODO

: SUMARJI
:
Jabatan /Title : Surveyor/Inpection

Alamat/Addres : Jl. Sentra BISNIS Harapan Indah,

Blok SS 19 No 07 Bekasi
Untuk melaksanakan/To canry Out : SUPERVISION LOADING BG.GABRIELLA II

Atas Permintaan/on Request of Messrs : CV.JAYA SEMESTA

Di/at : EAST, KALTIM

yang berkempentingan membawa alat-alat yang The surveyors are aquipped with the necessary
diperlukan untuk tugas tersebut diatas. aquipment to execute the job

kepada pihak-pihak / Instalasi yang berwenang, Authorities are requested to give assistance
dengan ini mohon bantuannya dan untuk itu kami whiche may required for which we appreciate wery much
mengucapkan terimakasih.
this assigment letter is valid from DECEMBER 14 2022
Surat Tugas ini berlaku sejak tanggal until the completed of job
DECEMBER 14 2022 sampai yang bersangkutan
selesai mengerjakannya.
Jakarta DECEMBER 14 2022
PT. Surya Buana Inpectindo

( …............................) RAHMAT WIDIANTO

Mater Loading Chief Officer DIRECTOR

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 SURAT TUGAS
ASSIGMENT LETTER

PT. Surya Buana Inpectindo as the

respensentative of CWN Survey & Inspection
assign the under mentioned staff (s)

SANTO WIDODO

Surveyor/Inpection

Jl. Sentra BISNIS Harapan Indah,

Blok SS 19 No 07 Bekasi

CV.JAYA SEMESTA

EAST, KALTIM

The surveyors are aquipped with the necessary

aquipment to execute the job

Authorities are requested to give assistance

whiche may required for which we appreciate wery much

until the completed of job

ASSOCIATION OF :
CWM SURVEY & INSPECTION
HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
21) 88976250, 44780055 Fax (62-21) 88976250
suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL

DATE : JANUARY - - 2023 PORT : KAMPUNG BARU

VESSEL : BG.GABRIELLA II BERTH : KAL-TIM
CARGO : CRUDE PALM OIL

The following details were supplied by the vessel's personnel from vessel's previous cargo records.
We cannot be responsible for any inaccuracies.

NO L / PORT DATE LOAD CARGO BL SF AL SF BD RECIVED

TOTAL

RATA-RATA

R1 R2 R3 R4
NO
DIFF % DIFF % DIFF % DIFF %
1 % % % %

2 % % % %

3 % % % %

4 % % % %

5 % % % %

TOTAL % % % %

RATA2 % % % %

Yours faithfully, Acknowledged receipt by

( WAHYU NURDIANTO ) ( )
SURVEYOR CHIEF OFFICER

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL

BERITA ACARA PEMUTUSAN SEGEL

BEFORE LOADING
VESSEL : BG.GABRIELLA II
CARGO : CRUDE PALM OIL
QUANTITY :
LOAD PORT : KUYUNG
DISCH PORT : JETTY PT.KRN

Dengan ini kami surveyor PT.SURYA BUANA INSPECTINDO yang ditunjuk

PT.KUTAI REFINERY NUSANTARA untuk melakukan survey pemuatan CRUDE PALM OIL
dengan jumlah muatan Pada kapal BG.FORTUNA 25
Bersama ini kami menyatakan bahwa sebelum dilakukan pemuatan segel dari pelabuhan pembongkaran
Dilaksanakan pemutusan semua segel ,dengan perincian, sbb :

VESSEL'S
MANHOLE SOUNDING PIPE VALVE IN OUT CARGO KONDISI
TANK NO

Demikian berita acara pemasangan segel ini dibuat dengan disaksikan oleh pihak terkait

(………………………) (………………………)
Attending Surveyor Shipper CHIEF OFFICER

ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
MEMBER OF
The assosiation of
independent survetors indonesia
LAPORAN TALLY SURVEY
LOADING

NAMA KAPAL : BG.GABRIELLA II

JENIS MUATAN : CRUDE PALM OIL
NOMINASI MUAT : MT
PENGIRIM : PT.KUTAI REFINERY NUSANTARA
PEMBELI : CV.JAYA SEMESTA

Bersama ini kami laporkan hasil pemuatan / pembongkaran CRUDE PALM OIL dari/ke kapal
BG.GABRIELLA II
Sesuai dengan hasil perhitungan tally yang kami lakukan, maka dapat kami sampaikan data
pemuatan/ pembongkaran sebagai berikut :

NO TANGGAL WEIGHT TRUCK KETERANGAN

1 JANUARY - - 2023 UNIT

2 JANUARY - - 2023 UNIT

3 UNIT

TOTAL

Demikianlah laporan ini kami buat sesuai dengan kondisi kejadian lokasi

Dibuat oleh Disaksikan oleh Diketahui oleh

( HENDRI S ) ( …………………………..) (………………..…………..)

Surveyor PT.SBI Chief officer Pihak Pabrik
 ASSOCIATION OF :
CWM SURVEY & INSPECTION
Head Office : SENTRA BISNIS HARAPAN INDAH BLOK SS 19 NO 7, BEKASI, INDONESIA
Telephone (62-21) 88976250, 44780055 Fax (62-21) 88976250
E-mail : suryabuana_inspectindo@ymail.com
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
WEIGLISHT
VASSEL : BG.GABRIELLA II
SHIPPER : PT.KUTAI REFINERY NUSANTARA PAGE :
BUYER : CV.JAYA SEMESTA
CARGO/QUANTITY : CRUDE PALM OIL
PLACE AND DATE : KAMPUNG BARU JANUARY - - 2023

NO TRUCK GROSS TARRE NETTO NO TRUCK GROSS TARRE NETTO

SUB TOTAL SUB TOTAL

SUB TOTAL SUB TOTAL

SUB TOTAL SUB TOTAL

PINDAHAN : PINDAHAN :
GRAND TOTAL : GRAND TOTAL :

ACKNOWLEDGE BY, SURVEYOR

( …........................) (…...........................................)
 INDEPENDENT SURVEYOR, MARINE & CARGO INSPECTION, FUMIGATION & PEST CONTROL
TALLY SHEET
KAPAL : BG.GABRIELLA II
PENGIRIM : PT.KUTAI REFINERY NUSANTARA PAGE :
PENERIMA : CV.JAYA SEMESTA
BARANG : CRUDE PALM OIL
TEMPAT & TANGGAL : KAMPUNG BARU JANUARY - - 2023

NO TRUCK SOPIR JAM NETTO NO TRUCK SOPIR JAM NETTO

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

0 0

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

0 0

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

0 0

TOTAL : TOTAL :

ACKNOWLEDGE BY, SURVEYOR

( …........................) (…...........................................)