INSPECTION AND TEST PLAN FOR CIVIL WORK (SITE)

Project : Revamp Ammonia Plant-2 Project M : Monitor P : Provide V : Verify Doc. No. 005
Location : Bontang R : Review W : Witness SW : Spot Wittness Rev 000
H : Hold Point
Client : PT Pupuk Kalimantan Timur
RESPONSIBILITY
LEVEL OF ACCEPTANCE /
REMARKS
METHOD OF REFERENCE CODE & VERIFYING ACCEPTANCE
No. INSPECTION ACTIVITY/TEST ITEM
INSPECTION STANDARD, OTHER DOCUMENT CRITERIA WIKA PTM
RELEVAN DOCUMENT

1.0 SURVEY
a. Location, number, stability and protection of coordinates and
Benchmark Visual & Dimensional IFC Drawing Survey Report Asper Plot Plan Dwg. P SW

2.0 SITE PREPARATION

a. Clearing of contaminated soil Visual Spesifikasi Sipil & Struktur : P SW
Site Preparation Report Asper Plot Plan Dwg.
Pekerjaan Tanah, Parg. 6
d. Demolition Visual Spesifikasi Sipil & Struktur : P SW
Site Preparation Report Asper Plot Plan Dwg.
Pekerjaan Tanah, Parg. 6
e. Debris from clearing, grubbing, stripping and demolition operation Spesifikasi Sipil & Struktur :
shall be remove to disposal areas Visual Pekerjaan Tanah, Parg. 6 Site Preparation Report Asper Plot Plan Dwg. P SW

f. Temporary Drainage Spesifikasi Sipil & Struktur : P R

Site Preparation Report Asper Plot Plan Dwg.
Pekerjaan Tanah, Parg. 6

3.0 EXCAVATION
1 Preparation
a. Set location, based on shop drawing and Benchmark Dimensional IFC Drawing Excavation Work Report Asper Plot Plan Dwg. P R
b. Demolition or Protection of Existing Facility Visual IFC Drawing Excavation Work Report Asper Plot Plan Dwg. P R
c. Investigation of Existing under-ground Facilities Visual IFC Drawing Excavation Work Report Asper Plot Plan Dwg. P R
2 Excavation Work
a. Depth and width of excavation Dimensional IFC Drawing Excavation Work Report Asper Plot Plan Dwg. P R
b. Line, Slope and Grades according to approved drawing Visual IFC Drawing Excavation Work Report Asper Plot Plan Dwg. P R
c. Protection of Slope, Visual Spesifikasi Sipil & Struktur : P R
Pekerjaan Tanah, Parg. 6 Excavation Work Report Asper Plot Plan Dwg.

d Compaction Test after excavation, confirmed (if Required) Visual Spesifikasi Sipil & Struktur : P W
Pekerjaan Tanah, Parg. 8 Sand Cone Report Min. CBR 5%, MDD 90%

e. Cleaning Visual Spesifikasi Sipil & Struktur : P R

Pekerjaan Tanah, Parg. 6 Excavation Work Report Asper Plot Plan Dwg.

4.0 BACKFILL
1 Preparation
a. Cleaning before backfill Visual Spesifikasi Sipil & Struktur : P R
Backfill Report Asper Plot Plan Dwg.
Pekerjaan Tanah, Parg. 7
b. Back fill material Visual Spesifikasi Sipil & Struktur : P SW
Backfill Report Asper Plan Dwg.
Pekerjaan Tanah, Parg. 7
2 Placement of fill
a. Cleaning (removal of trash debris, etc.) in soil Visual Spesifikasi Sipil & Struktur : P R
Backfill Report Asper Plan Dwg.
Pekerjaan Tanah, Parg. 7
b. Filling around underground pipe and cable (if any) Visual Spesifikasi Sipil & Struktur : P SW
Backfill Report Asper Plan Dwg.
Pekerjaan Tanah, Parg. 7
c. Final Elevation Dimensional IFC Drawing Survey Data Report (Backfill) Asper Design Dwg. P SW

3 Testing
a. Compaction test by Dynamic Cone Penetration (If Required) Test Spesifikasi Sipil & Struktur : P W
Sand Cone Report Min. CBR 5%, MDD 90%
Pekerjaan Tanah, Parg. 8
4 Final Visual Inspection Visual IFC Drawing Backfill Report Asper Design Dwg. P SW

5.0 CONCRETE WORK

1 Preparation
a. Cement type, quality, quantity and compliance with applicable Test & Review Spesifikasi Sipil & Struktur : Mill Certificate & SNI 2049 : 2013 P R
standard Pekerjaan Beton, Parg. 5 Laboratory Test
LPM / MAS
b. Quality and quantity of aggregate (sieve test, etc.) Test Spesifikasi Sipil & Struktur : Mill Certificate & ASTM C33 P R
Pekerjaan Beton, Parg. 5 Laboratory Test
c. Mix Design Review Spesifikasi Sipil & Struktur : P R
Trial Mix of Concrete Report SNI 2000
Pekerjaan Beton, Parg. 6
d. Trial Mix Test Spesifikasi Sipil & Struktur : P W
Trial Mix of Concrete Report SNI 2000
Pekerjaan Beton, Parg. 6
f. Storing condition of cement and aggregate Visual Spesifikasi Sipil & Struktur : P R
ACI 301M
Pekerjaan Beton, Parg. 5
g. Location and surface condition of joints Visual & Dimensional Spesifikasi Sipil & Struktur : P SW
Pekerjaan Beton, Parg. 9 Pre Pouring Concrete ACI 301M

h. Cleaning prior to concrete placing Visual Spesifikasi Sipil & Struktur : P SW

Pre Pouring Concrete ACI 301M
Pekerjaan Beton, Parg. 12
2 Concrete Pouring
a. Workmanship of placing and consolidation (drop height, thickness Visual Spesifikasi Sipil & Struktur : P SW
Pouring Concrete ACI 301M
of layer, proper vibration, etc.) Pekerjaan Beton, Parg. 8
b. Concrete finishing and removal of laitance Visual Spesifikasi Sipil & Struktur : P SW
Pouring Concrete Asper Drawing
Pekerjaan Beton, Parg. 6
3 Post Concrete Pouring
a. Curing (period, method of preventing moisture loss) Visual Spesifikasi Sipil & Struktur : P SW
Pouring Concrete ACI 301M
Pekerjaan Beton, Parg. 13
b. Appearance of surface after form removal (honeycomb, crack, etc.) Visual Spesifikasi Sipil & Struktur : Punch List Report P SW
Pekerjaan Beton, Parg. 14 ACI 301M

c. Mortar finishing (level, chamber, crack, mortar proportion, etc.) Visual Spesifikasi Sipil & Struktur : Punch List Report P SW
Pekerjaan Beton, Parg. 14 ACI 301M

d. Dimensional inspection for completed casting Dimensional IFC Drawing Survey Report Asper Drawing P SW
4 Test
a. Concrete test (slump, compressive strength, etc.) Test Spesifikasi Sipil & Struktur : SW
Compressive Strength Test Sesuai Mix Design P
Pekerjaan Beton, Parg. 15
 INSPECTION AND TEST PLAN FOR CIVIL WORK (SITE)
Project : Revamp Ammonia Plant-2 Project M : Monitor P : Provide V : Verify Doc. No. 005
Location : Bontang R : Review W : Witness SW : Spot Wittness Rev 000
H : Hold Point
Client : PT Pupuk Kalimantan Timur
RESPONSIBILITY
LEVEL OF ACCEPTANCE /
REMARKS
METHOD OF REFERENCE CODE & VERIFYING ACCEPTANCE
No. INSPECTION ACTIVITY/TEST ITEM
INSPECTION STANDARD, OTHER DOCUMENT CRITERIA WIKA PTM
RELEVAN DOCUMENT

6.0 REINFORCING BAR WORK

1 Preparation
a. Compliance of material with standard, Mill Certificates Visual & Dimensional Spesifikasi Sipil & Struktur : P R
Material Receiving Report,
Pekerjaan Beton, Parg. 5 SNI 2052 : 2014
Laboratory Report
LPM / MAS
b. Mock up Sample with Tensile Test Tensile Test Spesifikasi Sipil & Struktur : Laboratory Report P W
Pekerjaan Beton, Parg.11,\ SNI 2052 : 2014
LPM / MAS
c. Handling and storing Visual Spesifikasi Sipil & Struktur : Material Receiving Report P R
ACI 301M
Pekerjaan Beton, Parg. 8
d. Workmanship in cold bending operation Visual Spesifikasi Sipil & Struktur : P R
Reinforcing Bar Installation ACI 301M
Pekerjaan Beton, Parg. 8
e. Surface cleaning (to be free from mud, dirt, grease, loose mill, Visual Spesifikasi Sipil & Struktur : P R
Reinforcing Bar Installation ACI 301M
scale, etc.) Pekerjaan Beton, Parg. 8

2 Installation
a. Location, shape, sizes, numbers, cleaning and spacing of bars Visual & Dimensional IFC Drawing / Barbending P SW
Reinforcing Bar Installation Asper Drawing
Schedule
b. Length and location of lap splice Visual & Dimensional IFC Drawing / Barbending P SW
Reinforcing Bar Installation Asper Drawing
Schedule
c. Rigidity of rebar assembly to withstand concrete pouring Visual Spesifikasi Sipil & Struktur : P SW
Reinforcing Bar Installation Asper Drawing
Pekerjaan Beton, Parg. 8
d. Strong condition (to prevent corrosion and deformation) Visual Spesifikasi Sipil & Struktur : P SW
Reinforcing Bar Installation Asper Drawing
Pekerjaan Beton, Parg. 8
e. Prohibiting item (welding) Visual Spesifikasi Sipil & Struktur : P SW
Reinforcing Bar Installation Asper Drawing
Pekerjaan Beton, Parg. 8

7.0 FORM WORK

1 Preparation
a. Quality and shape of material Visual Spesifikasi Sipil & Struktur : P R
Form Work Report Asper Drawing
Pekerjaan Beton, Parg. 7
b. Formwork fabrication Dimensional IFC Drawing / Barbending P R
Schedule Form Work Report Asper Drawing

2 Installation
a. Location, dimension, alignment, plumb and elevation Dimensional IFC Drawing Form Work Report Asper Drawing P R
b. Installation of embedded materials includingsetting of water-stop Visual & Dimensional Spesifikasi Sipil & Struktur : P R
board (location, elevation and rigidity) Pekerjaan Beton, Parg. 7 / IFC Form Work Report Asper Drawing
Drawing
c. Installation of embedded materials for pipe sleeper (level, Visual & Dimensional Spesifikasi Sipil & Struktur : P R
elevation, location, length, rigidity) Pekerjaan Beton, Parg. 7 / IFC Form Work Report Asper Drawing
Drawing
d. Stability against concrete placing and vibration (sufficiency of Visual Spesifikasi Sipil & Struktur : P R
support, shoring, form tie, etc.) Pekerjaan Beton, Parg. 7 / IFC Form Work Report ACI 347R
Drawing
e. Surface treatment (cleaning and form oil application) Visual Spesifikasi Sipil & Struktur : P R
Pekerjaan Beton, Parg. 7 / IFC Form Work Report ACI 347R
Drawing
f. Protection of form scaffolding Visual Spesifikasi Sipil & Struktur : P R
Pekerjaan Beton, Parg. 7 / IFC Form Work Report ACI 347R
Drawing

8.0 ANCHOR BOLT

1 Preparation
a. Compliance of material with standard, mill certificates Dimensional, Test Spesifikasi Sipil & Struktur : W W
ASTM A307 grade 5,
Pekerjaan Beton, Parg.11,\ Material Receiving Report
HSB C3125
LPM / MAS
b. Mock up Sample with Tensile Test Tensile Test Spesifikasi Sipil & Struktur : Laboratory Report ASTM A307 grade 5, P W
Pekerjaan Beton, Parg.11,\ HSB C3125
LPM / MAS
2 Installation
a. Location, direction, elevation and upside of template Visual & Dimensional Standard Dwg / IFC Drawing Anchor Bolt Report Asper Drawing W SW
b. Stability of template Visual Standard Dwg / IFC Drawing Anchor Bolt Report Asper Drawing W SW
c. Location, elevation, plumbness, size and number of anchor bolts or Visual & Dimensional Standard Dwg / IFC Drawing Anchor Bolt Report,
anchor boxes Asper Drawing W SW
Survey Report
d. Anchor Bolt protection against movement Visual Spesifikasi Sipil & Struktur :
Anchor Bolt Report AISC 303 W SW
Pekerjaan Beton, Parg.11
e. Protection and cleaning anchor bolt threads before and after Visual Spesifikasi Sipil & Struktur :
Anchor Bolt Report AISC 303 W SW
placing concrete Pekerjaan Beton, Parg.11

9.0 STEEL STRUCTURAL WORK

1 Preparation
a. WPS Review AWS D.1.1 WPS Document approval P R
b. Welder Qualification Test Test AWS D.1.1 Welder List Document approval P SW
c. NDE Procedure (if needed) Review AWS D.1.1 NDE Procedure Document approval P R
d. Material (conformity to specification and drawing) Visual & Dimensional AISC 303 Sect.8 ASTM A36 atau JIS P R
Material Receiving Report
LPM / MAS G3101 SS400
e. Mock up Sample with Tensile Test for Major Parts. Tensile Test AISC 303 Sect.8 ASTM A36 atau JIS P W
Laboratory Report
LPM / MAS G3101 SS400
f. Padding / Shim Plate Visual & Dimensional IFC Drawing Survey Report Asper Drawing P R
g. Determine centerline, elevation for column and beam Dimensional IFC Drawing Survey Report Asper Drawing P R
2 Installation
a. Check plumbness, centerline, etc Dimensional AISC 303 Sect.8 Verticality Report, Survey W SW
Report
AISC 303 Sect. 8
b. Inspection for high strength bolting Test ASTM A325, Torque Table for Torque Table W SW
Tightening Bolt Report
ASTM 325
c. Visual inspection for weld Visual AWS D1.1 Section 6 Visual Welding Report AWS D1.1 Table 6.1 W SW
 INSPECTION AND TEST PLAN FOR CIVIL WORK (SITE)
Project : Revamp Ammonia Plant-2 Project M : Monitor P : Provide V : Verify Doc. No. 005
Location : Bontang R : Review W : Witness SW : Spot Wittness Rev 000
H : Hold Point
Client : PT Pupuk Kalimantan Timur
RESPONSIBILITY
LEVEL OF ACCEPTANCE /
REMARKS
METHOD OF REFERENCE CODE & VERIFYING ACCEPTANCE
No. INSPECTION ACTIVITY/TEST ITEM
INSPECTION STANDARD, OTHER DOCUMENT CRITERIA WIKA PTM
RELEVAN DOCUMENT

d. NDE ( PT , MPI or UT ) if needed Test ASME V NDE Report Sesuai dokumen W R

Approval
 INSPECTION AND TEST PLAN FOR CIVIL WORK (SITE)
Project : Revamp Ammonia Plant-2 Project M : Monitor P : Provide V : Verify Doc. No. 005
Location : Bontang R : Review W : Witness SW : Spot Wittness Rev 000
H : Hold Point
Client : PT Pupuk Kalimantan Timur
RESPONSIBILITY
LEVEL OF ACCEPTANCE /
REMARKS
METHOD OF REFERENCE CODE & VERIFYING ACCEPTANCE
No. INSPECTION ACTIVITY/TEST ITEM
INSPECTION STANDARD, OTHER DOCUMENT CRITERIA WIKA PTM
RELEVAN DOCUMENT

10.0 ASPHALT HOT MIX WORK

1 Preparation
LPM / MAS
LPM / MAS BS 2654 : 1989 point
a. Mix Design Review 26076-120-YMC-DB50- P R
26076-120-YMC-DB50-H0001 A.3.5
H0001
LPM / MAS BS 2654 : 1989 point
b. Trial Mix Test Official Report P W
26076-120-YMC-DB50-H0001 A.3.5
2 Hot Mix Pouring
a. Thickness of layer, proper hand compactor) Visual Standard Dwg / IFC Drawing Survey Repot Asper Drawing P SW

b. Finishing Visual Standard Dwg / IFC Drawing Report Asper Drawing P SW

4 Test
a. Composition Test LPM / MAS BS 2654 : 1989 point
Report P W
26076-120-YMC-DB50-H0001 A.3.5
b. Marshall Test Test ASTM D1559-76 Report ASTM D2027-97 (2004) P W