PT.

PERTAMINA GAS
JASA PERANCANGAN, PENGADAAN DAN KONTRUKSI (EPC)
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING (ADK)
4,3 KM

HYDROSTATIC TEST PACKAGE

ADK-EPC-10-PRO-PID-001 / TP-03 / 2"-PG-01-0003-A02A

Piping Launcher Station

 JASA PERANCANGAN, PENGADAAN DAN KONTRUKSI
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING

HYDROSTATIC TEST PACKAGE

INDEX OF CONTENT

Project Tittle : Pembangunan Pipa Gas Alas Dara Kemuning Date :

Client : PT Pertamina Gas Report No. : 003/IOC/HTP/PTG-PBAS/X/2021
Main Contractor : PT Patra Badak Arun Solusi Page :

Discipline : Piping P&ID No : ADK-EPC-10-PRO-PID-001

Work Item : Pressure / Hydrostatic Test Test Package No : TP-03
Area : Launcher Station Isometric No : 2"-PG-01-0003-A02A

INDEX OF CONTENT :

Yes N/A REMARKS

1. P & ID Drawing Test Block Limits

2. Isometric Drawing Test Limits

3. Welding Treaceability

4. Welding Schematic

5. Line Check Report

6. Punch List Report

7. Clearance for Hydrostatic Test

8. NDE Clearance

9. Calibration Certificate

10. Daily Welding

11. NDT Report

12. Pressure Test Report

13. Hydrostatic Test Report

14. Pressure & Temperature Chart

15. Flushing and Blowing Acceptance Cert.

16. Valve Installation Report

17. Flange Management Report

18. Completion Notice

Prepared by, Review/Witness/Approved by, Review/Witness/Approved by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi
QA - QC Representative/QC Representative/QC

Name Name Name

Sign Sign Sign

Date Date Date

 ENGINEERING, PROCUREMENT, & CONSTRUCTION
TRANSMISSION GAS PIPELINE PROJECT
GRESIK - SEMARANG

WORK INSPECTION REQUEST

To : Project Management Consultant ( PMC ) Request No. : ........./PTG-KWRK/PIP/P/WIR/........./16/02
PT. Bintang Persada Abadi ( BPA ) Date :
Gresik, East Java KWRK PIC : SUROSO

CC : -

DETAIL OF ACTIVITIES
TYPE OF TYPE OF
NO ACTIVITIES TIME LOCATION REPORT INSPECT REMARK INSPECTOR

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Date of Inspection : Type of Inspection

Time : A Joint Survey
Place : B Material Verification / Preparation
C Witnessing of Testing
Type of Report : D Release Hold Point
A Only this Report D Drawing E Visual for NDT
B Inspection Report E Survey Report F Punch List
C Testing Report F Heavy Equipment Report G Final Inspection
H Equipment and Tools Inspection
Attachment (if any)

RESULT/ CONCLUTION (by Employer/ Engineer) :

A Test / Inspection Result Satisfactory D No Objection & Proceed for Next Work
B Test / Inspection Result Unsatisfactory E No Objection with Remark
C Requires Re-Work and or Re-test F __________________________________
If result is B, C, or E, please put the note below :

Prepared / Reviewed by : Reviewed / Approved by :

Konsorsium WRK PERTAGAS Representative / PMC

______________________ ____________________________
Date : Date :
 WELDING TRACEABILITY RECORD
Project Tittle : Pembangunan Pipa Gas Alas Dara Kemuning P&ID No : ADK-EPC-10-PRO-PID-001 Date : 30-Dec-99
Client : PT Pertamina Gas Test Package No : TP-03 Report No. : 003/WTR/HTP/PTG-PBAS/X/2021
Main Contractor : PT Patra Badak Arun Solusi Isometric No : 2"-PG-01-0003-A02A Area : Launcher Station

Joint Material Designation Fit-Up / Welding Welder ID. Visual Test Non desdreuctive Testing (NDT)
Size THK/
Isometric Drawing Line No. Sheet Sp. Item Spec Heat No Electrode RT (Original) RT (RSC) RT (Repair 1) RT (Repair 2) UT (If Req) PT (If Req) MT (If Req)
(NPS) SCH Fit-Up Welding
No. Type RH FC Rep. No Date Result
From To From To From To RH FC Date Date Date Rep No. Result Stamp Date Rep No. Result Stamp Date Rep No. Result Stamp Date Rep No. Result Stamp Date Rep No. Result Date Rep No. Result Date Rep No. Result

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 2 SW 2 BW 2 Sch40 WN FLANGE PIPE A105 API 5L Gr. B 8A6994 626710 ER 70S-G E7018 7-Oct-21 7-Oct-21 001 001 PWV-014 7-Oct-21 Acc 7-Oct-21 RT-019 Acc

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 3 FW 3 BW 2 Sch40 PIPE TEE API 5L Gr. B A234 WPB 626710 94757104 ER 70S-G E7018 21-Oct-21 21-Oct-21 001 001 PWV-019 21-Oct-21 Acc 21-Oct-21 RT-029 Acc

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 3 FW 4 BW 2 Sch40 TEE PIPE A234 WPB API 5L Gr. B 94757104 626710 ER 70S-G E7018 21-Oct-21 21-Oct-21 001 001 PWV-019 21-Oct-21 Acc 21-Oct-21 RT-029 Acc

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 5 SW 5 BW 2 Sch40 PIPE WN FLANGE API 5L Gr. B A105 626710 8A6994 ER 70S-G E7018 1-Oct-21 1-Oct-21 001 001 PWV-010 1-Oct-21 Acc 3-Oct-21 RT-015 Acc

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 3 SW 6 BW 2 Sch40 TEE PIPE A234 WPB API 5L Gr. B 94757104 626710 ER 70S-G E7018 5-Oct-21 5-Oct-21 001 001 PWV-013 5-Oct-21 Acc 7-Oct-21 RT-019 Acc

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 3 FW 7 BW 2 Sch40 PIPE ELBOW 90 API 5L Gr. B A234 WPB 626710 94760129 ER 70S-G E7018 21-Oct-21 21-Oct-21 001 001 PWV-019 21-Oct-21 Acc 21-Oct-21 RT-029 Acc

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 4 GJ 8RW BW 2 Sch40 ELBOW 90 PIPE A234 WPB API 5L Gr. B 94760129 626710 ER 70S-G E7018 3-Nov-21 3-Nov-21 001 001 GJW-001 3-Nov-21 Acc

ADK-EPC-10-PIP-ISO-001 2"-PG-01-0003-A02A 3 of 7 4 GJ 9RW BW 2 Sch40 PIPE WN FLANGE API 5L Gr. B A105 626710 8A6994 ER 70S-G E7018 3-Nov-21 3-Nov-21 001 001 GJW-001 3-Nov-21 Acc

Notes : Prepared by, Review/Witness/Approved by, Review/Witness/Approved by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi
QA - QC Representative/QC Representative/QC

Name : Name : Name :

Date : Date : Date :
 JASA PERANCANGAN PENGADAAN DAN KONSTRUKSI
PEMBANGUNAN PIPA TRANSMISI GAS
ALAS DARA KEMUNING

PIPING WELDING SCHEMATIC

Company : PT Pertamina Gas Report No : 003/WSP/HTP/PTG-PBAS/IX/21
Contractor : PT Patra Badak Arun Solusi Date :
Project : Pembangunan Pipa Transmisi Gas Alas Dara Kemuning Area : Launcher Station

Type of Welding: SW FW FW SW SW FW GJ
Joint No : 2 3 4 5 6 7 8RW

Material Desg. : WN FLANGE PIPE TEE PIPE TEE PIPE ELBOW 90 PIPE

Heat No : 8A6994 626710 94757104 626710 94757104 626710 94760129 626710

Size (NPS) : 2 2 2 2 2 2 2 2

Thickness : Sch40 Sch40 Sch40 Sch40 Sch40 Sch40 Sch40 Sch40

Type of Welding: GJ
Joint No : 9RW

Material Desg. : PIPE

Heat No : 626710

Size (NPS) : 2

Thickness : Sch40
Type of Welding:
Joint No :

Material Desg. :

Heat No :

Size (NPS) :

Thickness :
Type of Welding:
Joint No :

Material Desg. :

Heat No :

Size (NPS) :

Thickness :
Type of Welding:
Joint No :

Material Desg. : Err:508

Heat No : Err:508

Size (NPS) : Err:508

Thickness : Err:508
Type of Welding: Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508
Joint No : Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508

Material Desg. : Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508

Heat No : Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508

Size (NPS) : Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508

Thickness : Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508 Err:508

Type of Welding: Err:508 Err:508 Err:508 Err:508 Err:508
Joint No : Err:508 Err:508 Err:508 Err:508 Err:508

Material Desg. : Err:508 Err:508 Err:508 Err:508 Err:508

Heat No : Err:508 Err:508 Err:508 Err:508 Err:508

Size (NPS) : Err:508 Err:508 Err:508 Err:508 Err:508

Thickness : Err:508 Err:508 Err:508 Err:508 Err:508

Type of Welding:
Joint No :

Material Desg. :

Heat No :

Size (NPS) :

Thickness :

Prepare by, Reviewed/Appoved by Reviewed/Appoved by

PT Patra Badak Arun Solusi PT Pertamina Gas Third Party

Name : Name : Name :

Date : Date : Date :
 JASA PERANCANGAN, PENGADAAN, DAN KONSTRUKSI (EPC)
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING (ADK)

Doc. No. :
Subject : LINE CHECK REPORT
Page :

Project : Location :

Client : PT Pertamina Gas Ref. Drawing :

RESULT
NO ITEM TO CHECK DATE & SIGN REMARKS
YES N/A

Remarks :

Prepared by, Approved by, Reviewed by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi

Date : Date : Date :

 PUNCH LIST REPORT
Project Title : Pembangunan Pipa Gas Alas Dara Kemuning Unit / Facility : Punch List No : /PLR/PIP/PTG-PBAS/ /2021
Dicipline : Piping Area : Launcher Station Portion :

Punch List Category Accepted

Item
Punch List Description Approved Target Date Date Cleared Remarks
No. A or B PBAS PTG
PBAS PTG

Note Category Description :

B : Must be completed After to Pre-Commissioning / Commissioning activity
A : Must be completed Before to Pre-Commissioning / Commissioning activity

PT PATRA BADAK ARUN SOLUSI PT PERTAMINA GAS

As Punch List Completed As Punch List Completed

Print Name

Signature

Date
 JASA PERANCANGAN, PENGADAAN DAN KONTRUKSI
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING

HYDROSTATIC TEST PACKAGE

CLEARANCE FOR HYDROSTATIC TEST

Project Tittle : Pembangunan Pipa Gas Alas Dara Kemuning Date :

Client : PT Pertamina Gas Report No. : 003/CLH/HTP/PTG-PBAS/X/2021
Main Contractor : PT Patra Badak Arun Solusi Page :

Discipline : Piping P&ID No : ADK-EPC-10-PRO-PID-001

Work Item : Pressure / Hydrostatic Test Test Package No : TP-03
Area : Launcher Station Isometric No : 2"-PG-01-0003-A02A

Item to be Cleared :
Yes No
1. All Punch list items have been corrected

2. All non conformance reports have been closed

3. Test equipments have been calibrated and correctly installed

4. All parts not be subjected to hydrostatic test have been removed

5. The QA/QC records and reports for this test package have been reviewed and are completed

6. NDE have been cleared

Design Pressure : barg (psig)

Test Pressure : barg (psig)

Holding Time : Minutes

The above test pressure have already checked by piping engineer / Sign, Name & Date

1. All Punch list items have been corrected

2. All non conformance reports have been closed

3. Test equipments have been calibrated and correctly installed

4. All parts not be subjected to hydrostatic test have been romeved

5. The QA/QC records and reports for this test package have been reviewed and are completed

6. NDE have been cleared

THE ABOVE PIPELINE INSTALLATION READY FOR HYDROSTATIC TEST

Prepared by, Review/Witness/Approved by, Review/Witness/Approved by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi
QA - QC Representative/QC Representative/QC

Name : Name Name

Sign : Sign Sign

Date : Date Date

 JASA PERANCANGAN, PENGADAAN DAN KONTRUKSI
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING

HYDROSTATIC TEST PACKAGE

NDE CLEARANCE

P&ID No : ADK-EPC-10-PRO-PID-001 Date :

Test Package No : TP-03 Report No. : 003/NCL/HTP/PTG-PBAS/X/2021
Isometric No : 2"-PG-01-0003-A02A
Location : Launcher Station

SUMMARY : ADK-EPC-10-PRO-PID-001 / TP-03 / 2"-PG-01-0003-A02A

1. Total Joint Butt Weld = 8 Joint

2. Total Joint Fillet Weld = 0 Joint

3. Total Joint Radiographic = 6 Joint

4. Total Joint Liquid Penetrant = 0 Joint

NDT RELEASE = YES NO

Prepared by, Review/Witness/Approved by, Review/Witness/Approved by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi
QA - QC Representative/QC Representative/QC

Name Name Name

Sign Sign Sign

Date Date Date

 JASA PERANCANGAN, PENGADAAN DAN KONTRUKSI
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING

HYDROSTATIC TEST PACKAGE

CLEARANCE FOR HYDROSTATIC TEST

P&ID No : ADK-EPC-10-PRO-PID-001 Date :

Test Package No : TP-03 Report No. :
Isometric No : 2"-PG-01-0003-A02A
Location : Launcher Station

THE THINGS STATED IN THIS DOCUMENT PACKAGE HAVE BEEN EVALUATED

BASED ON CLIENT'S CONDITION AND SPECIFICATION
THE INSPECTION REPORT OF CONTRACTOR HAS BEEN COMPLETED AND APPROVED BY ALL PA

NDT
Welding
Location RT PT
Joint ( Qty ) Joint ( Qty ) Joint ( Qty

Launcher Station 0 Err:508 Err:508

Signature
No. Activity Remarks
PBAS Pertamina Gas
1 Welding Acceptance
2 Welding Schematic Acceptance
3 NDE Acceptance
4 Line Check Acceptance

THIS PACKAGE IS READY FOR HYDROSTATIC TEST ACTIVITY

Prepared by, Review/Witness/Approved by,

PT Patra Badak Arun Solusi PT. Pertamina Gas
QA - QC Representative/QC

Name : Name :

Sign : Sign :

Date : Date :
OSTATIC TEST PACKAGE
CE FOR HYDROSTATIC TEST

S DOCUMENT PACKAGE HAVE BEEN EVALUATED

T'S CONDITION AND SPECIFICATION
OR HAS BEEN COMPLETED AND APPROVED BY ALL PARTIES

NDT
PT
Joint ( Qty )

Err:508

Remarks

ADY FOR HYDROSTATIC TEST ACTIVITY

 PIPANISASI PENGAPON BOYOLALI
PT PERUSAHAAN GAS NEGARA Tbk PT PGAS SOLUTION

INSPECTION REPORT WELDING for PIPING

Location : Report No. :
Line No. : : Date :
ISO Drawing No. : Page : of

Joint MATERIAL Welder ID No.

DWG Fit-Up Visual Dia.
No. WPS NO. Filler Metall NDE PWHT Remarks
Sht No. Check Check Inch
NO. Type Specification / Component Size Heat No. Sch. / Thk Piping Class R F/C

Note : SW = Shop Weld FW = Field Weld BW = Butt Weld FT = Fillet Weld RT = Radiography Test PT = Penetrant Test Total Dia Inch.

Prepared/Inspected by, Reviewed/Approved By, Reviewed by,

PT. PGAS SOLUTION PT. PERUSAHAAN GAS NEGARA Perusahaan Inspeksi

(--------------------------------------) (--------------------------------------) (--------------------------------------)

Date : Date : Date :

 JASA PERANCANGAN, PENGADAAN DAN KONTRUKSI
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING

HYDROSTATIC TEST PACKAGE

COMPLETION NOTICE

P&ID No : ADK-EPC-10-PRO-PID-001

Test Package No : TP-03

Isometric No : 2"-PG-01-0003-A02A

Location : Launcher Station

Description of Completion :

1. Completion No. = 003/CN/HTP/PTG-PBAS/X/2021

2. Date of Completion =

3. Test Package No. = TP-03

4. Location Point = Launcher Station - 2"-PG-01-0003-A02A

Statement of Completi :

1. Non-Destructive Examination ( NDE ) of The Above Mentioned package has been completed

as required in accordance with project specification

2. Welding History Sheet and NDE Clearance of The Package are hereby attached with this completion

3. Test Pressure in accordance with approved test block diagram

Prepared by, Review/Witness/Approved by, Review/Witness/Approved by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi
QA - QC Representative/QC Representative/QC

Name Name Name

Sign Sign Sign

Date Date Date

 Project : Pembangunan Pipa Transmisi Gas Gresik - Semarang
Contract No. : SP-203/PG0300/2014-SO
Department : QA - QC

Welding History
Weld Welding Data
Material
Type Kinds Radiography Test
No. Welding Rod Proses Welder ID / Rep. Welding 1 Rep. Welding 2
Line Number Size Length BW / FW / No. Joint Joint To Material Electroda GTAW / SMAW Report No. Date Weld. Stamp Fit Up Visual RT RT RT
Name Material Heat No Diameter (Inch) ( mm ) TRD Status Report No. Date
SW / FW Welder ID No. Report Date Welder ID No. Report Date
 Non Destructive Test (NDT)
Hidrotest
Radiography Test Ultrasonic Penetrant Magnetic
PWHT PMI HB Remarks
R1 R1 R2 R2 UT UT PT PT MT MT C/O C/O Date Rep/Film Result Report No.
Status Date Status Date Status Report No. Status Report No. Status Report No. Result Report No. Date
 JASA PERANCANGAN, PENGADAAN, DAN KONSTRUKSI (EPC)
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING (ADK)

Doc. No. : /LTR/PTG-PBAS/ /2021

Subject : LEAK TEST REPORT
Page :

Project : Location :

Client : PT Pertamina Gas Ref. Drawing :

RESULT
NO ITEM TO CHECK DATE & SIGN REMARKS
YES N/A

Remarks :

Prepared by, Approved by, Reviewed by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi

Date : Date : Date :

 JASA PERANCANGAN, PENGADAAN, DAN KONSTRUKSI (EPC)
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING (ADK)

Reference No. : Date :

Document Tittle : Page :

Subject : PRESSURE TEST RECORD Report No. : /PTR/PTG-PBAS/ /2021

LINE UNDER TEST :

P & ID NO. :

DESIGN PRESSURE : ( Kg / cm² / G ) / bar

TEST PRESSURE : ( Kg / cm² / G ) / bar AIR TEMP : °C

DURATION OF TEST : house / minutes

Start of Test End of Test

Time

Pressure

Temperature

DATE OF TEST :

TEST MEDIUM :

RECORDING INST. / PRESSURE GAUGE : CHECK CALIBRATION

Yes N/A
TEST RESULT : ACCEPTED / REJECTED

Yes N/A
ATTACHED : HYDRO AND TEMPERATURE CHART

Remarks :

Prepared by, Approved by, Reviewed by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi

Date : Date : Date :

 JASA PERANCANGAN, PENGADAAN, DAN KONSTRUKSI (EPC)
PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING (ADK)

SUBJECT : FLUSHING AND BLOWING ACCEPTANCE CERTIFICATE

REFERENCE NO. :

DOCUMENT TITTLE :

HYDROSTATIC TEST APPROVED : YES NO

LINE NUMBERS :

P & ID NO. :

FROM POINT :

TO POINT :

MEDIUM :

DATE :

DURATION :

REMARKS :

Comment

Prepared by, Approved by, Reviewed by,

PT Patra Badak Arun Solusi PT Pertamina Gas Perusahaan Inspeksi

Date : Date : Date :