Doc.

No FORM-04-QA-G015
Quality Form Doc. For Project
Status
Revision 00
Date 08-Mei-20
Request For Approval Page 1 of 2

Project Name : Repair EQT Libo Biogas To : PT. Ivomas Tunggal

Project Id : 20SRF1455 From : PT. PBS
RFA No. : 001/LIBF/EQT/RFA/04/2021 Location : Libo Biogas

Date: 21 April 2021

We submit the Following for your approval :

✘ Material (s) Brochure (s) ✘ Method statement (s) Shop Drawing (s) Proposal (s) Others

Description:

Ijin Pekerjaan : Grouting Dinding Repair EQT

Dengan Hormat,

Mohon persetujuannya untuk dapat dilakukan Grouting dinding Untuk area sebagai Berikut :
1. Kolom Agitator No. 1 dan 2
2. Dinding No. 1 dengan ukuran mal bekisting 7,2 x 3,5 m
3. Dinding No. 2 dengan ukuran Mal bekisting 12, 7 x 1,2 m
4. Dinding No. 3 dengan ukuran mal bekisting 3,6 x 3,5 m

Permukaan yang akan dilakukan grouting area yang sudah selesai Cipping dan permukaan dinding tidak nampak besi yang
terbuka.

Signature:

Name: Ali Masruf

To The Contractor: Date:

Your Request Is:

Approved Returned for Correction Approred on Condition as Noted Disapproved as Note

Notes:

Signature:

Name :

Original to  Construction Manager (to be returned to contractor)

Copy to  PM
 QA
 Doc. No FORM-04-QA-G015
Quality Form Doc. For Project
Status
Revision 00
Date 08-Mei-20
Request For Approval Page 2 of 2