Form No.

KIK-ME-PT-05
STAGNANT TEST RECORD
( TES RENDAM\)

House No ( Rumah No ) : ……………………… Equipment No. ( Alat No ) : ………………………

Cluster ( Cluster ) : ……………………… Service ( Pekerjaan ) : ………………………
Room ( Ruang) : ……………………… Drawing Ref. ( Ref. Gambar ) : ………………………
Contractor ( Konttraktor) : ………………………

- Pressure load ( Beban tekan)

2 bar 4 bar
3 bar

- Test Duration Time ( Durasi Waktu Tes )

2 hours (2 jam ) 8 hours (8 jam) 24 hours (24 jam )
4 hours (4 jam ) 12 hours ….. Hours ( jam )

- Test Time ( Waktu Tes )

Start (Awal ) date ( tanggal )
Finish (Akhir) date ( tanggal )

- Test Result ( Hasil Tes )

Good (baik)
Locked (terkunci)
Blocked (mampet)

- Drawing Reference (Referensi Gambar)

Attached (terlampir)
Not Attached (tidak terlampir)

Test Result (Hasil Tes) Test Equipment ( Alat Tes ) Remarks & Comments (Catatan & Komentar)
: Approved
( disetujui )
: Approved as Not
( disetujui dg catatan)
: Repeat Test
( tes diulangi )
Checked by ( diperiksa oleh ) , Proposed by ( diajukan oleh )
PT. KENDAL INDUSTRIAL PARK

(ME Coord.) (Inspector)