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Approval Material DUSASPUN U-Ditch

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PERSETUJUAN MATERIAL

Material Approval
Kontraktor/ Contractor : PT. Jaya Obayashi
Proyek/ Project : Modification Gutter Slope Area - 7
No.
Tgl. I Date : 12 August 2021
1. Jenis Material
Material T voe Saluran Terbuka Type U-Ditch
2. Produksi dari
Product by DUSASPUN
3. Supplier
DUSASPUN
4. Sub Contractor
Sub Kontraktor PT. Sinar Cipta Konstruksi
5. Referensi - No. Gambar
Reference - Drawing No. SL-A-01 (Site Plan)
- Spesifikasi Teknis
- Technical Specification Saluran Terbuka Type U-Ditch
- Lain-lain
- Others
6. Spesifikasi teknis yang diajukan
Technical Specification to be proposal Saluran Terbuka Type U-Ditch
400 X 470 X 1200

7. Lokasi
Location
8. Bagian Pekerjaan □ Concrete □ Stair □ Wall □ Floor
Scope of Work □ Ceiling □ Roofing □ Door/ Window □ Curtain Wall
□ Painting □ Partition □ Electrical □ CCTV
□ Piling □ Sound System □ Telephone □ Fire Alarm
□ Lightning P □ BAS □ Gensel □ Plumbing
□ □ □

Sanitair Fire Fighting Lift/ Excavator D Deep Well
□ Fence □ STP □ Signage □ Parking landscape
Others


9 Dasar Persetujuan Sesuai/ Tidak sesuai dengan gambar FOC
Evaluation Base Match/ Not Match with FOG drawing


Sesuai/ Tidak sesuai dengan Spesifikasi Teknis
Match/ Not Match with Technical Specificattion
Mutu : Baik/ Cukup/ Jelek
Quality : Good! Sufficient/ Bad
10 Berdasarkan evaluasi contoh material tersebut □ Accepted/ diterima
After Evaluated the samples, the material □ Reiected/ ditolak
11. Material tersebut dinyatakan □ Diijinkan dikirim ke proyek
Statement for the Material Allowed to Send to Project
□ Tidak/ belum diijinkan dikirim ke proyek
Not Allowed/ Not Allowed Yet to Send to Project
□ Harus dilakukan test mutu/ laboratorium
Have to be Tested for Quality/ Laboratory Test
Catalan ( diisi oleh Manajemen Konstruksi )
Notes ( filed by Engineer)

Disetujui/ Tidak Disetujui Diajukan oleh


Approved/ Not Approved Proposed by:
Representative Client Contractor
PT. ASTRA DAIHATSU MOTOR- KAP PT. JAVA OBAYASHI

Allan Yustian Wardi Sadam


Form No. QP-006-18

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