Form IR Civil Proyek PLTMG MERAUKE-20 MW (Contoh)

CONSORTIUM WIKA - WRK
PLTMG MERAUKE 20 MW
SITE INSTRUCTION
Originator : Action by :
……………… …………………………….
PT. WIKA Subcont : ………………….
Section / Area :
Document/Drawing ref :
Title :
Description :
Issued for : Reply Notice
This instruction must be completed on date : ………………,2017
Raised by , Acknowledge,
Yusuf Kurniawan
Manager ………… Project Manager
Copy of answered to Originator
INSTRUCTION
Date :
……………………. , 2017
No. :MRK - SI - WIKA - …….. - ……..

Action
Responsible,
Kurniawan
Subkont : …………..
CONSORTIUM WIKA
PLTMG MERAUKE 2
MERAUKE
PUNCH LIST
1 General (GE): *
Preparation (PR): * Report No : KBT-PL-WIKA-QAC-
*
*
Reference Drawing No.:
Balance of Plant (BP): *
2 Location :
3 Inspection Date & Time:

Day : Month : Year :
4 Inspection Items :
Contractor
NO Item Chek PT. WIKA
Prepared
OWNER CONSULTANT
PT.PLN
Witness Approved
Notes:
* : Chose according to Unit/Area
RTIUM WIKA - WRK
MERAUKE 20 MW
MERAUKE
PUNCH LIST
.:
Year : Hour : Minute :
Contractor CONSULTANT Owner

PT. WIKA PT. PLN Remark
Reviewed Approved Witness
CONTRACTOR
PT. WIKA
Reviewed Prepared
Consortium Wika
PLTMG MERAUKE
MERAUKE
HANDOVER INSPE
1 General (GE): * Reference Drawing No.:

Preparation (PR): *
*
*
2 Work :

Day: Month: Year: Hour:
NO Item Chek
Subcontractor
…………………………………….
QC / SPV
Notes:
ortium Wika - WRK
G MERAUKE 20 MW
MERAUKE
DOVER INSPECTION
FILE No : WC-851E03-QAC-…………..-HO02-………….
FORM : HO-002
Minute:
ACCEPTABLE
PT.Wijaya Karya (Persero) Tbk …………………………………
OK NO OK NO
Contractor
PT.Wijaya Karya ( Persero ) Tbk
( …………………………………………………… )
QC / SPV
Consortium Wika - WRK
PLTMG MERAUKE 20 MW
MERAUKE
INVITATION SHEET FOR JOINT IN

1 Building
General (GE): *
Preparation (PR): *
*
*
2 WorK AND Content of Inspection :
Date : Hour :
Month : Minute :
Year :
4 PT. WIKA CONSUL

Client's
Prepared Approv
Name :
Signature :
5 Client's Comment:
Client Inpection Witness:
Applicable
Not Applicable
Inspector's Name : PT.WIKA Consultant
1. ……………………………………………1. ………………………
2. ……………………………………………2. ………………………
3. ……………………………………………3. ………………………
Remarks :
Notes:
tium Wika - WRK
MERAUKE 20 MW
MERAUKE
Date :
Time :
ET FOR JOINT INSPECTION
:
:
CONSULTANT PT.PLN
Approved Witness
Consultant PT. PLN (Persero)
1. ………………………………………………
1. ………………………………………
2. ………………………………………………
2. ………………………………………
3. ………………………………………………
3. ………………………………………
Consortium Wika - WR
PLTMG MERAUKE 20 MW
MERAUKE
APPLICATION SHEET FOR PT. PLN (Perse
1 General (GE): * Reference Drawing No.:

Preparation (PR): *
*
*
2 WorK :

Day: Month: Year:
5 Attendant's Name CONTRACTOR
Consortium WIKA - WRK
Prepared Reviewed
Signature
Name
6 Content of Inspection :
7 Client's Comment:
Client Inpection Witness : Aplicable / Not Applicable
Change on Inspection Date : Yes, Day : Month : Year :

: No.
Inspector's Name : CONSORTIUM WIKA -WRK Consultant P
1. ……………………………………………
1. ……………………
2. ……………………………………………
2. ……………………
3. ……………………………………………
3. ……………………
Remarks :
Notes:
um Wika - WRK
MERAUKE 20 MW
MERAUKE
OR PT. PLN (Persero) INSPECTION
FILE No. : WK-851E03-QAC-……-AP01-….…

FORM ID : AP-001
Hour: Minute:
ONTRACTOR SUPERVISOR OWNER
rtium WIKA - WRK PT.Rekadaya Elektrika PT.PLN
Reviewed Approved Witness
th : Year : Hour : Min :
Consultant PT. REKADAYA PT. PLN (Persero)
1. ……………………………………………1. …………………………………………….
2. ……………………………………………2. …………………………………………….
3. ……………………………………………3. …………………………………………….
INSPECTION RECORD
BENCHMARK & GRID LINE
FILE No. : WK-851E03-QAC-……-IR02-….…

FORM ID : IR-002
1 General: *
Preparation: *
* Reference Drawing No.
*
Balance of Plant: *
2 Work: Survey work
3 Inspection Items: Benchmark, Grid line survey

Day: Month: Year: Hour: Minute:
5 Attendant's Name CONSORTIUM WIKA - WRK PT. PLN
Prepared Reviewed Approved
Name
Signature
6 Content of Inspection:
1. Coordination of Benchmark (X & Y Coordination)

2. Level of Benchmark
3. Grid line position
4. Stability & Protection of Benchmark
7 Result of Inspection
Actual Allowable
Design Value Judgment
Measure Tolerance
BENCHMARK
X Coordination ± 2 mm
Y Coordination ± 2 mm
Level ± 2 mm
Protection
GRID LINE
X Direction ± 2 mm
Y Direction ± 2 mm
8 Client's Comment:
Approved / Not Approved

INSPECTION RECORD
PILE WORK (DRIVING)
FILE No. : WK-851E03-QAC-……-IR03-….…
FORM ID : IR-003
1 General: *
Preparation: *
* Reference Drawing No. :
*
Balance of Plant: *
2 Work:
Pile Work (Driving)
3 Inspection Items:
Pile Bearing Capacity

5 Attendant's Name SUBCON CONSORTIUM WIKA - WRK PT. PLN
Prepared Prepared Reviewed Approved
Name
Signature
1. Calculation of Pile Bearing Capacity by use of Final

penetration depth & rebound
Refer to attached "Table"
8 Client's Comment :

INSPECTION RECORD
PILE WORK (POSITION)
File No. : WK-851E03-QAC-……-IR04-….…

Form ID : IR-004
*
1 General:
*
Preparation:
*
Reference Drawing No.
*
*
Balance of Plant:
2 Work: Pile work (Position)
3 Inspection Items: Location & Level of Pile Head
Name
Signature
1. Pile head location (X coordination, Y coordination)
2. Pile head level
Design Actual
Pile No. Allowable tolerance Judgment
Value Measure
Pile – 1
X Coordination Min. of (D/4 or 100 mm)
Y Coordination Min. of (D/4 or 100 mm)

Level 0 ~ +50mm
Pile – 2
X Coordination Min. of (D/4 or 100 mm)
Y Coordination Min. of (D/4 or 100 mm)

Level 0 ~ +50mm
8 Client's Comment:

INSPECTION RECORD
EARTH WORK (EXCAVATION)
File No. : WK-851E03-QAC-……-IR05-….…

Form ID : IR-005
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Earth Work
3 Inspection Items: Excavated Level

Name
Signature
1. Excavated level
Excavated area
A B
C D
Allowable
Design Value Actual Measure Judgment
tolerance
Excavated Level ±20mm
A ±20mm
B ±20mm
C ±20mm
D ±20mm
E (Center) ±20mm
8 Client's Comment:

INSPECTION RECORD
EARTHWORK (GRAVEL BASE)
File No. : WK-851E03-QAC-……-IR06-….…

Form ID : IR-006
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Earthwork (Foundation Gravel Base)
3 Inspection Items: Gravel Base Level

Name
Signature
1. Gravel Base Level
Gravel area
Design Actual
Allowable tolerance Judgment
Value Measure
Gravel Base Level
A -30 ~ +10mm
B -30 ~ +10mm
C -30 ~ +10mm
D -30 ~ +10mm
E (Center) -30 ~ +10mm
8 Client's Comment:
INSPECTION RECORD
EARTHWORK (BACKFILLING)
File No. : WK-851E03-QAC-……-IR07-….…

Form ID : IR-007
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Earthwork
3 Inspection Items: Compaction

Name
Signature
1. Compaction (Field Dry Density Test)
Design Actual Allowable

Judgment
Value Measure Value
Field Dry Density Test

95%
“A”
95%
“B”
95%
“C”
95%
“D”
For Details, refer to attached sheet
8 Client's Comment:

INSPECTION RECORD
FIELD DENSITY TEST SAND CONE METHOD
Company : CONSORTIUM PT.WIKA - WIKA REKAYASA KONSTRUKSI File No. : WK-851E03-QAC-……-IR08

Project : PLTMG MERAUKE - 20 MW Form ID : IR-008
MERAUKE Date : ……………………………..
Sampel Description : Layer # …...….
Sampel Location : ..............................
Result of Laboratory Test for Filling Material
Maximum Dry Density : 1,33 t/m3
SUBCON PT. WIKA - WRK

Name
Signature
No Description Unit Sample No. Sample No. Sample No.
"A" CALIBRATION FOR SAND IN FUNNEL
1 Initial wt. Of Sand / Apparatus g
2 Final wt. Of Sand / Apparatus g
3 Wt. of Sand in Funnel g =(1)-(2) 1485.17 1485.17 1485.17
"B" WT. OF SOIL TAKEN FROM MOLD
4 Wt. of wet soil / container g
5 Wt. of wet container g
6 Wt. of wet soil g =(4)-(5)
"C" VOLUME OF MOLD
7 Wt. of Sand before test / Apparatus g
8 Wt. of Sand after test / Apparatus g
9 Total Wt. Of sand used g =(7)-(8)
10 Wt. of sand remaining in hole g =(9)-(3)
11 Unit Wt of sand g/cm3 1.4820 1.4820 1.4820
12 Volume of hole cm3 =(10)/(11)
"D" MOISTURE CONTENT
13 Wt. of wet sample / pan g
14 Wt. of dry sample / pan g
15 Wt. of water g =(13)-(14)
16 Wt. of pan g
17 Wt. of dry sample g =(14)-(16)
18 Moisture content % =(15)/(17)

"E' DENSITY COMPUTATION
19 Wet Density t/m3 =(6)/(12)
20 Dry Density t/m3 =(19)/(1+(18))
21 Maximum dry density t/m3 1.33 1.33 1.33
22 Compaction % =(20)/(21)x100%
1E03-QAC-……-IR08-….…
……………………..
PT. PLN
Sample No. Sample No.
1485.17 1485.17
1.4820 1.4820
1.33 1.33
FIELD DENSITY TEST SAND CONE METHOD
Sampel Description : File No. : WK-851E03-QAC-……-IR08-….…
Form ID : IR-008
Sampel Location : Date :
Result of Laboratory Test for Filling Material
Maximum Dry Density t/m3 Optimum Moisture Content %
Witness PLN
Name
Signature
UNIT Sample No. Sample No. Sample No. Sample No.
“A” CALIBRATION FOR SAND IN FUNNEL
1 Initial wt. Of Sand / Apparatus g
2 Final wt. Of Sand / Apparatus g
3 Wt. of Sand in Funnel g =(1)-(2)
“B” WT. OF SOIL TAKEN FROM MOLD
4 Wt. of wet soil / container g
5 Wt. of wet container g
6 Wt. of wet soil g =(4)-(5)
“C” VOLUME OF MOLD
7 Wt. of Sand before test / Apparatus g
8 Wt. of Sand after test / Apparatus g
9 Total Wt. Of sand used g =(7)-(8)
10 Wt. of sand remaining in hole g =(9)-(3)
11 Unit Wt of sand g/cm3
12 Volume of hole cm3 =(10)/(11)
“D” MOISTURE CONTENT
13 Wt. of wet sample / pan g
14 Wt. of dry sample / pan g
15 Wt. of water g =(13)-(14)
16 Wt. of pan g
17 Wt. of dry sample g =(14)-(16)
18 Moisture content % =(15)/(17)
“E” DENSITY COMPUTATION
19 Wet Density t/m3 =(6)/(12)
20 Dry Density t/m3 =(19)/{1+(18)}
21 Maximum dry density t/m3
22 Compaction %
INSPECTION RECORD
EARTH WORK (BACKFILL FINISHED LEVEL)
File No. : WK-851E03-QAC-……-IR09-….…

Form ID : IR-009
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Earth Work
3 Inspection Items: Backfill Finish Level

Name
Signature
1. Backfill Finish Level
Backfilled Area
A B
C D
Design Actual
Value Measure
Excavated Level
A ±20mm
B ±20mm
C ±20mm
D ±20mm
E (Center) ±20mm
8 Client's Comment:
INSPECTION RECORD
CONCRETE WORK (LEVELING CONCRETE)
FILE No. : WK-851E03-QAC-……-IR10-….…

FORM ID : IR – 010
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Concrete Work (Leveling concrete)
3 Inspection Items: Leveling concrete finished level

Name
Signature
1. Leveling Concrete Finish Level
Leveling concrete area
Design Actual
Value Measure
Leveling Concrete Level
A ±10mm
B ±10mm
C ±10mm
D ±10mm
E (Center) ±10mm
8 Client's Comment:

INSPECTION RECORD
CONCRETE WORK (POSITION)
FILE No.: WK-851E03-QAC-……-IR11-….…

FORM ID: IR – 011
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Concrete Work (Position)
3 Inspection Items: Measurement of Foundation Center Lines

Name
Signature
1.From Benchmark & Grid line to Center Line

of Foundation (X & Y Coordination)
Design Value Actual Measure Allowable tolerance Judgment
Center of Building
X Coordination ±2mm
Y Coordination ±2mm
8 Client's Comment:

INSPECTION RECORD
CONCRETE WORK (REBAR & FORMWORK)
FILE No. :
FORM ID :
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Concrete Work (Rebar & Formwork)
3 Inspection Items: Rebar, Formwork
4a Inspection Date & Time:

4b Expected Concrete Cast :
5 Attendant's Name CONSORTIUM WIKA - WRK PT. PLN
Prepared Reviewed Approved
Name
Signature
1. Bar Arrangment
Bar Diameter
Number of Rebars
Spacing of Rebars
Rebar Cover
Lap Length
2. Formwork
Inside Dimension
Finished Level
3. Anchor Bolts
Position
Level
4. Embedded Metal
Position
Level
PT. WIKA PT. PLN
Date Sign Date Sign
Rebar
Diameter As per drawings
Number As per drawings
Spacing As per drawings
Cover As per drawings
Lap Length Exceed length
Formwork
Anchor Bolts
Embedded Material
Position As per drawings
Level As per drawings
8 Client's Comment:

INSPECTION SHEET FOR FORMWORK & ANCHOR
BOLT BEFORE CONCRETE POURING
COMPANY : Consortium Wika - Wika Rekayasa Konstruksi

PROJECT : PLTMG MERAUKE 20 MW
MERAUKE
FILE No. : WK-851E03-QAC-……-IR13-….…
ITEM NAME : FORM ID : IR-013
DWG No. : SHEET OF
REV. :
REVIEWED/WITNESSED
ITEM DESCRIPTION PT. WIKA PT. PLN / PT. Rekadaya
DATE SIGN DATE SIGN
1 FORM WORK - DIMENSION ALIGNMENT COLUMN
- FORM OIL COATING WALL
- STABILITY BEAM
- TOP ELEVATION SLAB
- CHAMPER, SPACER Pile Cap
PHT
2 ANCHOR BOLT / BOX - SIZE, TYPE

EMBEDDED STEEL, WATER - NUMBER
STOP - LOCATION
- ORIENTATION
- LEVEL
- STABILITY
- PROTECTION OF ANCHOR BOLT SCREW
3 MISC : OPENING SLEEVE, etc - DIMENSION

- LOCATION
- ORIENTATION
- MATERIAL
REMARK :
Approved by, Reviewed by, Prepared by,

PT. PLN Consortium Wika - WRK SUBCON
( ...........................) ( ...........................) ( ......................... )

INSPECTION RECORD
CONCRETE WORK (READY MIX BEFORE POURING)
COMPANY : Consortium Wika - Wika Rekayasa Konstruksi FILE No. :

PROJECT : PLTMG MERAUKE - 20 MW FORM ID:
MERAUKE SHEET : ……………..OF…………….
LOCATION : DATE :
STRUCTURE NAME : QUANTITY :
ELEVATION :
PLACING TEMP. :
REQUIRED CURIN:
DESIGN MIX : K175

CEMENT TYPE : TYPE I TYPE II TYPE V
SLUMP : CM
REQUIRED FINISH : SMOOTH / ROUGHNESS *)
CIVIL : : DATE :
PIPING : : DATE :
MECHANICAL : : DATE :
ELECTRICAL : : DATE :
SURVEY : : DATE :
ENGINEERING / QC PRE POUR APPROVALS
PT. WIKA
ENGINEERING : : DATE :
QUALITY CONTROL : : DATE :
WEATHER : SUNNY / CLAUDY / RAIN / DRIZZLE

PLACEMENT STARTED DATE : TIME :
PLACEMENT COMPLETED DATE : TIME :
NUMBER OF CYLINDER : NOS, ACTUAL SLUMP : CM
CYLINDER CODE :
CONCRETE TESTED BY :
REMARK :
Approved by, Reviewed by, Prepared by,

PT. PLN CONSORTIUM WIKA - WRK SUBCON
( ......................... ) ( ......................... ) ( ......................... )

INSPECTION RECORD
CONCRETE WORK (AFTER POURING)

FORM ID: IR – 015
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Concrete Work (After Pouring)
3 Inspection Items:

Name
Signature
Design Value Actual Measure Allowable tolerance Judgment
Foundation dimension & Level Refer to Attachment

Surface Condition
Consolidation No Honeycomb
Color No different color
Voids Rerer to note below
Anchor Bolts Refer to Attachment
Note: Type “A” for exposed to view & Type “B” for exposed to earth as per ACI 309
8 Client's Comment:

INSPECTION RECORD
CONCRETE WORK (AFTER POURING)

FORM ID: IR – 017
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Concrete Work (After Pouring)
3 Inspection Items: Compression Strength Test

Attendant's Name SUBCON CONSORTIUM WIKA - WRK PT. PLN
Name
Signature
1. For 3 days Compression Strength Test
Refer to Attachment
8 Client's Comment:

INSPECTION RECORD
COMPRESSIVE STRENGTH OF CONCRETE
COMPANY : Consortium WIKA - Wika Rekayasa Konstruksi FILE No. : WK-851E03-Q

PROJECT : PLTMG MERAUKE - 20 MW FORM ID: IR – 018
MERAUKE ITEM NAME : ………………
SUBCONTROCTOR :
MIX : …………….. (kg/cm2), Cylinder / Cube CEMENT = ……………………..

SLUMP : …………….. cm F / AGG. = ……………………..
W/C RATIO : …………….. bwc C/ AGG = ……………………..
Max size aggr. : …………….. mm ADD. = ……………………..
CHARACTERISTIC OF MATERIALS
Specific Gravity
- Cement Type I/II PC/PCC : Tigaroda - Indocement / Tonasa = ……………………..

- Sand (ssd basic) : Ex Kintapura = 2,618
- Split (ssd basic) : Ex Karang Jawa = 2,819
- Water : Water Supply = 1,000

- Additive : Puzzolith 101 RI = 1,20
AGGRETAGE (Kg) Additive

WATER CEMENT
DESCRIPTION Puzzolith 101 RI
(Ltr) (Kg)
FINE COARSE (ml)
Condition SSD
Water Content (%) 4.944 1.534
Absorption (%) 1.678 2.558
Mix Proportion (Volume = 0,5 m3)
Mix Design Proportion
Adjustment (Absorption of Aggregate)
Trial Mix Design
REMARK : COMPRESSIVE STRENGTH TEST

NO DATE
1
3
Merauke, ………………
Approved by, Reviewed by,
PT. PLN Consortium Wika - WRK
( ...........................) ( ...........................) ( ...............

ECTION RECORD
STRENGTH OF CONCRETE
FILE No. : WK-851E03-QAC-……-IR18-….…

FORM ID: IR – 018
ITEM NAME : ……………………………
Kg/m3
%
%
% bwc
gr/cc
gr/cc
gr/cc
gr/cc
gr/cc
TOTAL
REMARK
(Kg/m3)
Proportion (Volume = 0,5 m3)
COMPRESSIVE STRENGTH TEST

REMARKS
AGE (DAYS)
Refer to
Attached
Form ID :
IR-022
Merauke, ………………………...……. 2017
Prepared by,
PT. DOLAROSA
( ...........................)
INSPECTION RECORD
STEEL STRUCTURE WORK
FILE No. : WK-851E03-QAC-……-IR19-….…

FORM ID: IR – 019
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Steel Structure Work (Before Erection)
3 Inspection Items: Measurement of Level of Packer Plate

5 Attendant's SUBCON CONSORTIUM WIKA - WRK PT. PLN
Name
Signature
1. Top Level of Packer Plate
Design Actual
Value Measure
Column Number
C1 ±3.0mm
C2 ±3.0mm
C3 ±3.0mm
C4 ±3.0mm
C5 ±3.0mm
C6 ±3.0mm
C7 ±3.0mm
8 Client's Comment:

INSPECTION RECORD
FILE No. : WK-851E03-QAC-……-IR20-….…

FORM ID: IR – 020
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Steel Structure Work (During Erection)
3 Inspection Items: Inspection of Alignment

Name
Signature
1. Column Alignment
2. Rectilinear of Beam
3. Level of Floor Girders
4. Inclination of Structures
5.Deformation of Structures
Actual
Design Value Allowable tolerance Judgment
Measure
Column Alignment Min of (H/1000 or 10mm)
Min of (L/1000+3mm or
Rectilinear of Beam
10mm)
Level of Floor Girders ±5mm
Min of (H/4000+7mm or
Inclination of Structures
30mm)
Deformation of Structures Min of (L/4000 or 20mm)
8 Client's Comment:

INSPECTION RECORD
FILE No. : WK-851E03-QAC-……-IR21-….…

FORM ID: IR – 021
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Steel Structure Work (Crane Rail)
3 Inspection Items: Inspection of Alignment of Crane Rail


Name
Signature
1. Span
2. Differential level between two Rails
3. Inclination of Rail
Actual
Design Value Allowable tolerance Judgment
Measure
Span Min of (H/1000 or 10mm)
L < 25M ±10mm

25 ≤ L<40 ±15mm
Differential level
ð / L ≤ 1/1000
between two Rails
Inclination of Rail Inclination ≤ 1/1000
8 Client's Comment:

INSPECTION SHEET FOR
COMPRESSIVE STRENGTH TEST RESULT
COMPANY : CONSORTIUM WIKA - WIKA REKAYASA KONSTRUKSI

PROJECT : PLTMG MERAUKE 20 MW
MERAUKE
SUBCONTRACTOR :
SPECIMEN : CYLINDER / CUBE *
DIMENTION : (15X30) CM / (15X15) CM *
NUMBER : …………………....PCS
COMPRESSIVE
DATE OF DATE OF AGE AREA WEIGHT SLUMP MAXIMUM
NO LOCATION CODE STRENGTH
POURING TEST (DAYS) (CM)2 (KG) (CM) LOAD (KG)
fc' (KG/CM2)
Notes:
Approved by, Tested by, Reviewed by,

PT. PLN PT.DOLAROSA PT. WIKA -WRK
(………………………………………) (……………….………………………) (………………………………………)

INSPECTION SHEET FOR
ESSIVE STRENGTH TEST RESULT
COMPRESSIVE STRENGTH AT
TESTING KG/CM2 REMARKS
TEST DAY 28 DAYS
MERAUKE,……………………..2017
Prepared by,
SUBCON
(………………………………………)
INSPECTION RECORD
Bonna Pipe Installation
FILE No. : WK-851E03-QAC-……-IR23-….…
Form ID : IR - 023
1 General:: *
Preparat: *
* Reference Drawing No. CB-
*
Balance of Plant: *
2 Work: Bonna Pipe Installation
3 Inspection Items:

5 Attendant's Name WIKA-Civil
MC- TEPSCO
PLN-JBN
Electric/Mech ENGINEER INSPECTOR
Name
Signature
1. Pipe Diameter
2. Position
3. Elevation
7 Remarks:
Allowable
Pipe No. Design Value Actual Measure Judgment
Tolerance
Pipe -1
X Coordination
Y Coordination
Elevation
Pipe - 2
X Coordination
Y Coordination
Elevation
9 Client's Comment:

INSPECTION RECORD
GROUTING WORK
FILE No. : WK-851E03-QAC-……-IR24-….…
FORM ID :IR - 024

1 General: *
Preparation: *
*
Balance of Plant: *
2 Work:
3 Inspection Items:

Day: Month: Year: Hour: Minutes:
SUB CONTRACTOR Consortium Wika-WRK
5 Attendant's Name PT. PLN
Prepared Prepared Reviewed
Name
Signature
6 Content of Inspection :
7 Result of Inspection :
Design Actual
Value Measure
Cement Type Cement Type V
Surface Condition
Consolidation No Honeycomb
Color No different color
Voids Refer to note below
8 Client's Comment:

INSPECTION RECORD
CONCRETE TEMPERATURE RECORD
COMPANY : Consortium Wika - Wika Rekayasa Konstruksi FILE No. : WK-851E03-QAC-……

PROJECT : PLTMG MERAUKE 20 MW FORM ID: IR-026
LOCATION : ………………………………………… DATE : ………………………
STRUCTURE NAME: ………………………………………… QUANTITY: ………………………
Bottom 1 Middle 2 Top 3 Surface

Maximum - - - - - - -
Minimum - - - - - - -
Average - - - - - - -
Location/ Structure ……………………………………………………………………………………………………
Total Temperature ( oC )
No Date Time
Hours Bottom 1 Middle 2 Top 3 Surface
1 15-Dec-2009 8:00 - - - -
2 9:00 - - - -
3 10:00 - - - -
4 11:00 - - - -
5 12:00 - - - -
6 13:00 - - - -
7 14:00 - - - - - - -
8 15:00 - - - - - - -
9 16:00 - - - - - - -
10 17:00 - - - - - - -
11 18:00 - - - - - - -
12 19:00 - - - - - - -
13 20:00 - - - - - - -
14 21:00 - - - - - - -
15 22:00 - - - - - - -
16 23:00 - - - - - - -
17 16-Dec-2009 8:00 - - - - - - -
18 10:00 - - - - - - -
19 12:00 - - - - - - -
20 14:00 - - - - - - -
21 16:00 - - - - - - -
22 18:00 - - - - - - -
23 20:00 - - - - - - -
24 22:00 - - - - - - -
25 17-Dec-2009 8:00 - - - - - - -
26 11:00 - - - - - - -
27 14:00 - - - - - - -
28 17:00 - - - - - - -
29 18-Dec-2009 8:00 - - - - - - -
30 11:00 - - - - - - -
31 14:00 - - - - - - -
32 17:00 - - - - - - -
33 19-Dec-2009 8:00 - - - - - - -
34 11:00 - - - - - - -
35 14:00 - - - - - - -
36 17:00 - - - - - - -
Total Temperature ( oC )
No Date Time
Hours Bottom 1 Middle 2 Top 3 Surface
37 20-Dec-2009 8:00 - - - - - - -
38 11:00 - - - - - - -
39 14:00 - - - - - - -
40 17:00 - - - - - - -
41 21-Dec-2009 8:00 - - - - - - -
42 11:00 - - - - - - -
43 14:00 - - - - - - -
44 17:00 - - - - - - -
45 22-Dec-2009 8:00 - - - - - - -
46 11:00 - - - - - - -
47 14:00 - - - - - - -
48 17:00 - - - - - - -
Notes:
a. The difference temperature between top and surface are not larger than 20 o Celcius
b. The difference temperature between layer to layer are not larger than 25 o Celcius
ECTION RECORD
TEMPERATURE RECORD
FILE No. : WK-851E03-QAC-……-IR26-….…
…………………………………………
…………………………………………
4
Ambient Weather
- -
- -
- -
………………………………………………………………………………………..
Temperature ( oC )
4 Ambient Weather
-
-
-
-
-
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
Temperature ( oC )
4 Ambient Weather
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
INSPECTION SHEET FOR FORMWORK & ANCHOR BOLT BEFORE CONCRETE POURING
FILE No. : WK-851E03-QAC-……-IR25-….…

FORM ID: IR – 025
Location : ......................................................
1. Inside Dimension of Formwork Date : ......................................................
PLAN
I2 L2
Judgment
L1 Value Measure tolerance
a -5 ~+20mm
I1 b B
A -5 ~+20mm
b -5 ~+20mm
a
A B -5 ~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
Position / Coordinate
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
PLAN
x3 ± 1mm
x4 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
X ± 2mm
Y ± 2mm
L3 ± 3mm
SECTION
L4 ± 3mm
Elevation
H1 0 ~+5mm
H2 0 ~+5mm
H3 0 ~+5mm
H4 0 ~+5mm
Note: Total of (d1 + d2 + d3) shall not exceed ±10mm
Attendent's Name CONSORTIUM WIKA - WRK

Prepared Reviewed
Name
Signature
FILE No. : WK-851E03-QAC-……-IR27-….…

FORM ID: IR – 027
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
x3 ± 1mm
x4 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
y5 ± 1mm
y6 ± 1mm
X ± 2mm
Y ± 2mm
L3 ± 3mm
L4 ± 3mm
Elevation
H1 0 ~+5mm
H2 0 ~+5mm
H3 0 ~+5mm
H4 0 ~+5mm
H5 0 ~+5mm
H6 0 ~+5mm
Attendent's Name SUBCON CONSORTIUM WIKA - WRK PT. PLN

Name
Signature
FILE No. : WK-851E03-QAC-……-IR31-….…

FORM ID: IR – 031
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
x3 ± 1mm
x4 ± 1mm
x5 ± 1mm
x6 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
y5 ± 1mm
y6 ± 1mm
X ± 2mm
Y ± 2mm
L3 ± 3mm
L4 ± 3mm
Design Actual Allowable Design Actual Allowable

Elevation Judgment Elevation Judgment
Value Measure tolerance Value Measure tolerance
H1 0 ~+5mm H5 0 ~+5mm
H2 0 ~+5mm H6 0 ~+5mm
H3 0 ~+5mm H7 0 ~+5mm
H4 0 ~+5mm H8 0 ~+5mm

Name
Signature
FILE No. : WK-851E03-QAC-……-IR28-….…

FORM ID: IR – 028
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
x3 ± 1mm
x4 ± 1mm
x5 ± 1mm
x6 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
y5 ± 1mm
y6 ± 1mm
y7 ± 2mm
y8 ± 2mm
Elevation X ± 2mm
H3 0 ~+5mm Y ± 2mm
H4 0 ~+5mm L3 ± 3mm
H5 0 ~+5mm L4 ± 3mm
Elevation
H6 0 ~+5mm
H7 0 ~+5mm H1 0 ~+5mm
H8 0 ~+5mm H2 0 ~+5mm

Name
Signature
INSPECTION RECORD
CONCRETE WORK (BEFORE POURING)
FILE No. :
FORM ID: IR – 014
1 General: *
Preparation: *
*
Balance of Plant: *
2 Work: Concrete Work (Before pouring)
3 Inspection Items: Inspection for Ready Mixed Concrete

5 Attendant's Name SUBCON CONSORTIUM WIKA - WRK PLN
Name
Signature
1. Delivery Period
2. Slump
3. Percentage of Void
4. Amount of Chloride
5. Temperature of Concrete
Allowable
Design Value Actual Measure Judgment
tolerance
Delivery Period 1.5 hours

Slump 80 – 125 mm
Void ± 1.5 %
Chloride 0.3 kg/m3
Concrete Temperature 300C ~ 350C
8 Client's Comment:

Concrete Data Sheet for Structural Concrete
FILE No. : WK-851E03-QAC-……-CDS1-….…
FORM ID. : CDS – 001
Project No. : Date : Strength required : Mpa (kg/cm2)
Lot No. : Supplier : Max water permissible : L/m3
Pour Location : Recorded by: Required Conc. Temp Min : Max °C
Time Time Concrete Air Pour

Load Cumulative Time of Slump test Additive
Docket No. Volume (m3) beginning completed Temperature Temperature completion Notes
No. Volume (m3) Arrival (mm) (L)
discharge discharge °C °C time
Recarded by, Checked by Approved by,

PT. DOLAROSA Consortium Wika - WRK PT. PLN
( …………………………………………. ) ( …………………………………………. ) ( …………………………………………. )

INSPECTION SHEET FOR FORMWORK AND ANCHOR BOLT AFTER CONCRETE POURING
FILE No. : WK-851E03-QAC-……-IR16-….…

FORM ID: IR – 016
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
PLAN
x3 ± 1mm
x4 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
X ± 2mm
Y ± 2mm
L3 ± 3mm
SECTION
L4 ± 3mm
Elevation
H1 0 ~+5mm
H2 0 ~+5mm
H3 0 ~+5mm
H4 0 ~+5mm
Attendant's SUBCON CONSORTIUM WIKA - WRK

Name
Signature
FILE No. : WK-851E03-QAC-……-IR29-….…

FORM ID: IR – 029
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
x3 ± 1mm
x4 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
y5 ± 1mm
y6 ± 1mm
X ± 2mm
Y ± 2mm
L3 ± 3mm
L4 ± 3mm
Elevation
H1 0 ~+5mm
H2 0 ~+5mm
H3 0 ~+5mm
H4 0 ~+5mm
H5 0 ~+5mm
H6 0 ~+5mm

Name
Signature
FILE No. : WK-851E03-QAC-……-IR30-….…

FORM ID: IR – 030
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1a ± 1mm
x1b ± 1mm
x2 ± 1mm
x3a ± 1mm
x3b ± 1mm
x4 ± 1mm
x5a ± 1mm
x5b ± 1mm
x6 ± 1mm
x7a ± 1mm
x7b ± 1mm
x8 ± 1mm
y1a ± 1mm
y1b ± 1mm
y2 ± 1mm
y3a ± 1mm
y3b ± 1mm
y4 ± 1mm
y5a ± 1mm
y5b ± 1mm
y6 ± 1mm
y7a ± 1mm
Elevation y7b ± 1mm
H3 0 ~+5mm y8 ± 1mm
H4 0 ~+5mm X ± 2mm
H5 0 ~+5mm Y ± 2mm
Elevation
H6 0 ~+5mm
H7 0 ~+5mm H1 0 ~+5mm
H8 0 ~+5mm H2 0 ~+5mm

Name
Signature
FILE No. : WK-851E03-QAC-……-IR30-….…

FORM ID: IR – 030
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
x3 ± 1mm
x4 ± 1mm
x5 ± 1mm
x6 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
y5 ± 1mm
y6 ± 1mm
y7 ± 2mm
y8 ± 2mm
Elevation X ± 2mm
H3 0 ~+5mm Y ± 2mm
H4 0 ~+5mm L3 ± 3mm
H5 0 ~+5mm L4 ± 3mm
Elevation
H6 0 ~+5mm
H7 0 ~+5mm H1 0 ~+5mm
H8 0 ~+5mm H2 0 ~+5mm

Name
Signature
FILE No. : WK-851E03-QAC-……-IR32-….…

FORM ID: IR – 032
Location : ......................................................
PLAN
I2 L2
Judgment
-5
a
I1 b B ~+20mm
-5
A
~+20mm
-5
b
a ~+20mm
A -5
B
~+20mm
l1
SECTION l2
L1
d
3 L2
d
2 Elevation
d1 ±10mm
d
1 d2 ±10mm
d3 ±10mm
2. Anchor Bolts
x1 ± 1mm
x2 ± 1mm
x3 ± 1mm
x4 ± 1mm
x5 ± 1mm
x6 ± 1mm
y1 ± 1mm
y2 ± 1mm
y3 ± 1mm
y4 ± 1mm
y5 ± 1mm
y6 ± 1mm
X ± 2mm
Y ± 2mm
L3 ± 3mm
L4 ± 3mm
Design Actual Allowable Design Actual Allowable

Elevation Judgment Elevation Judgment
Value Measure tolerance Value Measure tolerance
H1 0 ~+5mm H5 0 ~+5mm
H2 0 ~+5mm H6 0 ~+5mm
H3 0 ~+5mm H7 0 ~+5mm
H4 0 ~+5mm H8 0 ~+5mm

Name
Signature
INSPECTION RECORD
COMPRESSION STRENGTH OF CONCRETE File No. :
Form ID : IR - 018
PROJECT NAME PLTMG MERAUKE 20 MW
CONTRACTOR CONSORTIUM WIKA - WRK
NAME OF TEST COMPRESSION STRENGTH OF CONCERETE
REFERENCE STANDARD ASTM. c39, ASTM. c192, ACI. 301
CLIMATIC CONDITION TEMP.(C) HUMIDITY(%) WATER TEMP DATE
CEMENT TYPE & TYPE 2 / TYPE 1

MANUFACTURER INDOCEMENT TIGARODA / TONASA
MIXTURE NO. PLACING LOCATION
BACTH QUANTITIES.kg.per.m3.OF ADMIXTURE

CONCRETE
COARSE AGG. (mm)
RANGE OF SLUMP
(cm)
RATIO (W/C) (%)

WATER CEMENT
COARSE AGG
CC/m3
RANGE OF AIR
(%)
MAX.SIZE OF
TYPE
PROPORTIONS
(%)
CEMENT
mm-mm mm-mm
WATER
SAND
DESIGN
20 10
S/A
SPECIMEN NO
AGE (days)
AVERAGE DIAMETER (mm)
SECTIONAL AREA (mm2)
AVERAGE HEIGHT (mm)
SLUMP (cm)
WEIGHT (kg)
MAXIMUM LOAD (kg)
COMPRESSIVE STRENGTH (N/mm2）S
MEAN VALUE OF COMP. STR (N/mm2）L
ALLOWABLE MIN. COMP STR. (N/mm2）L
TYPE OF FRACTURE
TESTED BY: LABORATORY/ENG. BY: M.H.I
WITNESSED BY:
REMARKS AIR %
PILE D
Pile Type Weight of

Driving
Date Pile. No. Diameter Hammer
Length (m) Length (m)
(T)
(m)
PILE DRIVING RECORD
File No : WK-851E03-QAC-……
Form ID : PDR -001
Number of Final
Drop Distance Rebound Design Actual
Hammer Drop Penetration
(mm) Measure (mm) Capacity (T) Capacity (T)
(No) (mm)
: WK-851E03-QAC-……-PDR1-….…
Judgment Remarks
Measurement on Pile Penetration
File No : WC-851E03-QAC-……-MPP1-….…
FORM ID : MPP-001
Month Day /
Pile No. No.
Pile Type Dia. X
Driving Depth m
No. of driving
Drop Height m
Rebound mm
Penetration Depth mm
FIELD SURVEY REPORT
LEVELING
FILE NO: WC-851E03
FORM ID : SR-001
PROJECT : PLTMG MERAUKE - 20 MW SURVEYOR
LOCATION : INSTR. NO.
TASK : PAGE NO.
DATE : BLOCK
No. ELEVATION
BM BS FS IH
Point DESIGN ACTUAL
SKETCH :
Approved by Reviewed by Reviewed by

PT. PLN CONSORTIUM WIKA - WRK
( …………………………. ) ( …………………………. ) ( …………………………. )

FIELD SURVEY REPORT
LEVELING
: WC-851E03-QAC-……-SR01-….…
FORM ID : SR-001
: …………………………………………………
: …………………………………………………
: ……………………..of………………………
: …………………………………………………
DISTANCE
REMARKS
( mm )
Prepared by
( …………………………. ) ( …………………………. )
SURVEY TOP ELEVATION OF EMBEDDED PLATE
BEFORE / AFTER CONCRETE
PT.PLN
FILE NO. : WK-851E03-QAC-……-SR02-….…
FORM ID : SR-002
PROJECT : PLTMG MERAUKE 20 MW SURVEYOR : ……………………………………………

LOCATION : INSTR. NO. : ……………………………………………
AREA : PAGE NO. : …………………..of……………………
DATE : BLOCK : ……………………………………………
Line Distance Elevation ∆H
No. Point Number IH Remark
Middle Above Bottom Optis Cumulative Design Actual + -
Approved by Reviewed by Reviewed by Prepared by
( …………….………………………….…………. ) ( …………….……………………………..……………. ) ( …………….……………………………...……………. ) ( ………………………………………...………………. )

SURVEY TOP ELEVATION OF ANCHOR BOLT
BEFORE / AFTER CONCRETE
FILE NO. : WK-851E03-QAC-……-SR03-….…
FORM ID : SR-003
PROJECT : PLTMG MERAUKE 20 MW SURVEYOR : ……………………………………………
LOCATION : INSTR. NO. : ……………………………………………
AREA : PAGE NO. : …………………..of……………………
DATE : BLOCK : ……………………………………………
Line Distance Elevation ∆H

No. Point Number IH Remark
Middle Above Bottom Optis Cumulative Design Actual + -
Approved by Reviewed by Reviewed by Prepared by

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

: PLTMG MERAUKE 20 MW
:
:
:
Horizontal Azimuth (a )
No Point Number Cor. Distance (d)
Deg Min Sec Deg Min Sec
Approved by Reviewed by
PT. PLN
( …………….………………. ) ( …………….………………. )
FIELD SURVEY REPORT
ACTUAL PILE COORDINATE
FILE NO. : WC-851E03-QAC-……-SR04-….…
FORM ID : SR-004
SURVEYOR
INSTR. NO.
PAGE NO.
BLOCK
Actual Coordinate Design Coordinate
E N E N E
Reviewed by Prepared by
( …………….………………. ) ( …………….………………. )
FILE NO. : WC-851E03-QAC-……-SR04-….…
: ……………………………………………
: ……………………………………………
: …………………..of……………………
: ……………………………………………
∆ Coordinate
Elevation
E N
( …………….………………. )

Form IR Civil Proyek PLTMG MERAUKE-20 MW (Contoh)

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Form IR Civil Proyek PLTMG MERAUKE-20 MW (Contoh)

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CONSORTIUM WIKA - WRK

This instruction must be completed on date : ………………,2017

No. :MRK - SI - WIKA - …….. - ……..

3 Inspection Date & Time:

Year : Hour : Minute :

Contractor CONSULTANT Owner

1 General (GE): * Reference Drawing No.:

3 Inspection Date & Time:

INVITATION SHEET FOR JOINT IN

3 Inspection Date & Time:

4 PT. WIKA CONSUL

Inspector's Name : PT.WIKA Consultant

ET FOR JOINT INSPECTION

Consultant PT. PLN (Persero)

APPLICATION SHEET FOR PT. PLN (Perse

1 General (GE): * Reference Drawing No.:

4 Inspection Date & Time:

Change on Inspection Date : Yes, Day : Month : Year :

Inspector's Name : CONSORTIUM WIKA -WRK Consultant P

OR PT. PLN (Persero) INSPECTION

FILE No. : WK-851E03-QAC-……-AP01-….…

Consultant PT. REKADAYA PT. PLN (Persero)

FILE No. : WK-851E03-QAC-……-IR02-….…

3 Inspection Items: Benchmark, Grid line survey

4 Inspection Date & Time:

1. Coordination of Benchmark (X & Y Coordination)

Approved / Not Approved

4 Inspection Date & Time:

1. Calculation of Pile Bearing Capacity by use of Final

Refer to attached "Table"

Approved / Not Approved

File No. : WK-851E03-QAC-……-IR04-….…

2 Work: Pile work (Position)

3 Inspection Items: Location & Level of Pile Head

4 Inspection Date & Time:

Day: Month: Year: Hour: Minute:

5 Attendant's Name SUBCON CONSORTIUM WIKA - WRK PT. PLN

Prepared Prepared Reviewed Approved

1. Pile head location (X coordination, Y coordination)

2. Pile head level

X Coordination Min. of (D/4 or 100 mm)

Y Coordination Min. of (D/4 or 100 mm)

X Coordination Min. of (D/4 or 100 mm)

Y Coordination Min. of (D/4 or 100 mm)

Approved / Not Approved

File No. : WK-851E03-QAC-……-IR05-….…

3 Inspection Items: Excavated Level

4 Inspection Date & Time:

Approved / Not Approved

File No. : WK-851E03-QAC-……-IR06-….…

3 Inspection Items: Gravel Base Level

4 Inspection Date & Time:

File No. : WK-851E03-QAC-……-IR07-….…

3 Inspection Items: Compaction

4 Inspection Date & Time:

1. Compaction (Field Dry Density Test)

Design Actual Allowable

Field Dry Density Test

For Details, refer to attached sheet

Approved / Not Approved

Company : CONSORTIUM PT.WIKA - WIKA REKAYASA KONSTRUKSI File No. : WK-851E03-QAC-……-IR08

SUBCON PT. WIKA - WRK

No Description Unit Sample No. Sample No. Sample No.