PTS Modification Work - Mist Precipitator APPENDIX - 2

DOCUMENT TRANSMITTAL FORM - 2 (1/2)

FROM VENDOR OR SUBCONTRACTOR TO SAE
To: Mr.Hirokazu Sato / Mr. Urfian Soegiharto
Project Manager / Deputy Project Manager Transmittal No. : -
From:
Vendor's or Subcontractor's Name & Address: Job No. : -
PT.HIKARI TEKNOLOGI INDONESIA Jl. Raya Requisition No. : -
Sukomulyo Km.23 Manyar Gresik 61151 Project No./ PO No. : 5M-020-007
Discipline : -
Date Issuence : 1/8/2016
Addition
Addition or
or deletion
deletion Job / Title : CASOX GAS COOLING TOWER
A
A -- Additional
Additional
By: M.Jannatun Na'im
IFI D
D -- Delete
Delete
Phone: 62-31-3951828
T
T -- Revise
Revise of
of title
title
E-mail: jannatunaim10@gmail.com
Facsimile: 62-31-3951838

The following document are submitted for :

x IFA IFC IFR IFI Page 1 of 1

Document for review must be returned by the dates indicated below in the column review required.
Addition or Deletion

SAE'S DISTRIBUTION MATRIX ( FILL IN BY EM / ORIGINATOR / INCHARGE )

Identification No.
INTERNAL ROUTING
Vendor or Subcon Doc.
No. Rev. No. Document Title No. of Shts.
Document No Size

EQP. No. REQ. No. or MR No. Ser.

Distr / Route Back

(Date)

SITE
1 2 3 (20 Col) 21 22 23 (20 Col) 43 44 45 (50 Col) 95 96 97 (Date) Sign

CM

BM

ME
PM

EM

QH

CV

DC
SC

PC

CS
PS

PP

EL
1 5M-020-007-CSD-MSD-028 1 Casox Gas Cooling Tower ST-26 Detail Drawing (1/2) A3 1 1/8/2016

2 5M-020-007-CSD-MSD-029 1 Casox Gas Cooling Tower ST-26 Detail Drawing (2/2) A3 1 1/8/2016

3 5M-020-007-CSD-MSD-035 1 Casox Gas Cooling Tower Ladder 24 A3 1 1/8/2016

4 5M-020-007-CSD-MSD-036 1 Casox Gas Cooling Tower Ladder 25 A3 1 1/8/2016

Note : If client comments are not received within 10 working days, the document is pressumed Automatically approved.
Internal
Internal Use SAE:
SAE: Instruction
Instruction to
to DC
DC ::
Copy : 1. Original to consignee The
The above
above document
document shall
shall be
be :
2. Please acknowledge receipt of the above listed items by signing and returning duplicate of this form VENDOR INCHARGE Distributed
Distributed with
with expected
expected return
return _____
_____ days.
days. By
By ___
___ // ___
___ // ___
___
3. File
SUBCON SC ADM Circulation/Route
Circulation/Route within
within _____
_____ Day(s)
Day(s) for
for each
each discipline.
discipline.
ISSUED BY : RECEIVED BY:
Discipline
Discipline Incharge:
Incharge:

(Name,
(Name, Signature
Signature Discipline)
Discipline)
M.Jannatun Naim Name, Signature

Rev.0
 PTS Modification Work - Mist Precipitator APPENDIX - 2
FORM - 2 (2/2)
DOCUMENT TRANSMITTAL
To: Mr.Ery Febrianto FROM VENDOR OR SUBCONTRACTOR TO PT. SAE
SAE ENGINEERING Transmittal No. :
From:
Vendor's or Subcontractor's Name & Address: Job No. :
PT HIKARI TEKNOLOGI INDONESIA Requisition No. :
JL. Raya Sukomulyo Km. 23 Manyar Gresik Project No./ PO No. :
(61151) Discipline :
Date Issuence :
Job / Title :
Addition
Addition or
or deletion
deletion
By: Hartono Muljohardjo A - Additional
D - Delete
Phone: (021) 8508640, 8192808 T - Revise of title
E-mail: marketing@wikabeton.co.id
Facsimile: (021) 85903872

The following document are submitted for :

x IFA IFC IFR IFI Page 1 of 1

Document for review must be returned by the dates indicated below in the column review required.
Addition or Deletion

SAE'S DISTRIBUTION MATRIX ( FILL IN BY EM / ORIGINATOR / INCHARGE )

Identification No.
INTERNAL ROUTING
Vendor or Subcon Doc.
No. Rev. No. Document Title No. of Shts.
Document No Size

EQP. No. REQ. No. or MR No. Ser.

Distr /
Route Back

SITE
HSE
1 2 3 (20 Col) 21 22 23 (20 Col) 43 44 45 (50 Col) 95 96 97 (Date) (Date) Sign

CM

BM

ME
PM

EM

QH

CV

DC
SC

PC

CS
PS

PP

EL
ORIGINATOR

Note : If client comments are not received within 10 working days, the document is pressumed Automatically approved.
Internal
Internal Use
Use SAE:
SAE:
Copy : 1. Original to consignee
Instruction
Instruction to
to DC
DC :
2. Please acknowledge receipt of the above listed items by signing and returning duplicate of this form VENDOR INCHARGE The
The above
above document
document shall
shall be
be ::
3. File
SUBCON SC ADM Distributed
Distributed with
with expected
expected return
return _____
_____ days.
days. By ___ // ___ // ___

ISSUED BY : RECEIVED BY: Circulation/Route

Circulation/Route within
within _____ Day(s)
Day(s) for
for each
each discipline.
discipline.

Discipline
Discipline Incharge:
Incharge:

I GEDE DWIJA PUTRA Name, Signature

(Name,
(Name, Signature
Signature Discipline)
Discipline)

Rev.0