PT. PERTA SAMTAN GAS re APPROVAL FORM Ref No Date : May 23, 2017 ‘* Subject Approval : Budget Execution of scaffolding Fix Platform Sampling Point Emission (what) © Background 1. Indonesian Legal compliance to Kepdal No KEP-205/BAPEDAL/07/1996 Pecoman Teknis Pengendalian Pencemaran Udara Sumber Tidak Bergerak (why) 2. Recommendation and finding from BLH KOTA Prabumulih : 60/545/BLH.1/2016 (why) 3. Follow up & action to Closing finding from BLH KOTA Prabumulih ; 660/545/BLH.V/2016 (why) 4. Internal Memo Ref. No. 012/BOD/V/17-IM Target Achievement on Green Proper PT Perta-Samtan Gas 5. Fix Platform Sampling Point to be done before assessment of Proper and ISRS on 2017. (when) * Purpose 1. Propose to install scaffolding fix platform of sampling point at GTC and Heater area Extraction Plant Prabumulih. (where) 2. For acces during sampling poit as required and madatory for Air Emission Handling Management. 3. To install fix platform and acces leader to 5 emission sampling point at GTC and 2 emission samping point at Heater (what) * Scope Of Work : - Execution on Q Il 2017 (when) - Conduct by competence contractor for construction (how) - Detail as attached (how) * Budget : No Scope of Work Total Price ] Material 7 _| Scafolding Pipe (RSP-B-24), Wall Thickness Min 2.4 mm 45,084.60 2 | Hot Dip Galvanize Metal Plank (RSP-12-1), Dimensi 250 mm x 40) eee aia eee zesary 3 _ | Hot Dip Galvanize Metal Plank (RSP-12-1), Dimensi 250 mm x 40) eared mm x4,2mmx2m 4 | Drop Forged Double Coupler (RDDC-B-486) 112347 5 _| Drop Forged Swivel Coupler (RDDC-B-466) 7701 6 _| Board Retainning Coupler (RBRC-G486) 3.1900 7 _ | Rendez Ratchet (RR-G-1921) 438.64 & _ | Rendez Ratchet (RR-G-1721) 746.209 Rendez Ratchet (RR-G-1779) 746.208 10 _| Usafe Full Body Hamess (SB-5120) 947.625) Grand Total (IDR) 71-784.90qPT. PERTA SAMTAN GAS © Attachments. - Recapitulation estimation cost and BOQ ie Namie Position Signature Name Position Signature ‘Acep Saefuddin O&M Manager ‘Syalful Anwar GM Operation Signature Proposed By Check & review by Approved by Name = Rudi Name: Maria Katryn Name = Aris Marhendrawanto Position: Act HSE Manager Position Finance Manager | Position : VP Director Signature Name :Leelun Hee Position: Internal Audit Manager Signature Name: Baek Weon Son Position : President Director Signaturesue j__Stee!_Angie L-50.50.5_ Se ge 0505 Floor Platform Steel Gratin Safety Guord ea Lge, J, 70.707 | stad Bate" ao Fp Te Ri mae wana bE Me seme ny 4519 £ we 1 Platform Emisi_ Check Point sealer a pe | 4 Steel Angle 1-50.50. {Steel Plate 5.50.6000 _ I Steel Angle 1-RO.80.8 — Floor Platform Steel Grating 1000 L pe | (beta base he . LL Safety Guard Stee! Plate 5.50.6000 Steel Ladder, found 1b f9.70.7 od View 2 Platform Emisi_Check Point ‘Scole: NTS: Nove Material Plar poor sat bering Sapottwis Aatsaas. Pree - ores | ed 00 T | Steel Angle L-50.50.5 T Steel Angle L-50.50.5 oO ra Tt | Floor Platform Steel Grating | Lt Stee! Angle L-80.80.8 [ | s = Revision = Joenjera tae Stee, Ladder, | 70.70.7 E z [aoe | ind Bor, 619mm Sofety Guord Stee! Plote 5.50.6000 4 (PRO PT PERTA- SAMTAN GAS Steel Ladder, L 70.70.7 Chimney Existing Round Bar, 19mm ‘Biv? = seachienl HSE ISRS & PROPER: proc Lin \ PLATFORM REGENT OAS & : HOTOR HEATER (Section 1 Platform Emisi Check Point Plon Platform Hot Emisi Check Point. ay scale: NT: Seale: NT me Tae We = wu | reoncrome [el s i o at 7 aot I REFERENCES= cy cy | ‘. naif Er Gt | ] a i Oo T © \3 Lit : t i EATS) L | i Ir I [ a 4 ADTE > SCAPOLDING PATFORM & Quit FoR TEMPORARY PATEORIA REOMeBeT Fe RATPORM eT BARE ON DetiGV R/ov/O'T SS OTE: aasesf aolt + Matertal Poplace wrth Yeapoleine malerral. Noe 1 Beam H. Ste! Stuctre Eistng 6 Column HSte GTC Bxseg 2 chimey Ie Exiting 7 Ladder Stel Stele GTC Hodes L 5 Enis Cuck Poit GTC Essing 8 st CS Pipe #82 Hara! GTC Star 4 Stam Cte TS07SES 8 trzrtl S Pipe 43.2 Hondo GTC Sheter ae '5 Beam Cte TEOISES 10 rang reer to sing ere ——® 9) Lore | HSE ISRS & PROPER PROGRAM PLATFORM EMIS! CHECK POINT GTC SHELTER-cHMNeY ¢ ‘segTON 1 PLATFORM EMIS| CHECK POINT JOP LEVEL OF CHNNEY Nore: © CHANEL STEEL 150.75.6.5, @ FLOOR STEEL GRATH HANDRAIL CS PIPE 2” & 1.5" # 32MM @ LODER STEEL STRUCTURE (REFER SSNP-GEN-CW-STD-028) dt sty [Hep me eS A MO PLATFORM EMIS! CHECK POINT (GTC SHELTER aoa pscorcivepacon |