DSLNG_CoverSheet_V-31D2-001-A-G615 Rev 5 Page 1 of 1

Total Sheet 1 + 12
VENDORs name

PT. McConnell Dowell Indonesia
OWNER's name

PT. DONGGI SENORO LNG
PURCHASERs name : PT. JGC INDONESIA AND JGC CORPORATION CONSORTIUM
Project name :

Donggi Senoro LNG Project

Purchase Order No.:

0-5151-P-31D2-001-A
Equipment/Material name : Common
Item number:



VENDORs document No.:
017-W003-2315 Rev. 5
Document title:

ITP for Precast Concrete Fabrication










DSLNG Project

ISSUE PURPOSE : FC

RESULT CODE : A, B, N, F ( )

NEXT STATUS : FA, FI, FC, AB ( )

RESUBMISSION DATE : ( )

RESPONSIBLE DEPT. : ( )

REVIEWED BY : ( )

( )

Review Date: ( )

A: Approved without Comment; B: Approved with Comment

N: Not Approved; F: Not Subject to Review

Approval or review hereunder shall not be construed to relieve Supplier / Subcontractor of
his responsibilities and liability under the Contract.

J OB NO. 0-5151-20

PURCHASER
ORIG. PURCHASE ORDER NO. SERIAL REV

DOC. NO.

V - 31D2-001-A - G615 5

A
NA
Civil
E.Sato
15th Sep 2011

INSPECTION AND TEST PLAN
Form No.
F001-017-2315


F001-017-2315 Rev 1 Page 1 of 3
Project Name: DS LNG Marine Project Project No.: 2315
Contractor: JGC CORPORATION


Construction Process: Precast Concrete Fabri cation ITP No.: 017-W003-2315
Rev
5


LEGEND

Verification Activity

H Hold Point - work shall not proceed past the Hold Point until
released by the organisation imposing the Hold Point.

W Witness Point - an inspection point that may be witnessed by the
organisation imposing the Witness Point.

I Inspection - formal inspection activity to be undertaken and
recorded.

S Surveillance - an activity that is subject to ongoing monitoring.

R Review - review of text reports/records or other evidence of
compliance.

SW Spot Witness - witness for major structure (precast beam, headstock
and superstructure, etc)

Responsible Inspectorate (RI) (may be modified to meet site specific requirements)

MDI McConnell Dowell Indonesia
DSLNG Donggi Senoro Liquefied Natural Gas
J GCC PT. J GC Indonesia and J GC Corporation Consortium
PM Project Manager
CM Construction Manager
SUP Supervisor
PQMR Project Quality Management Representative
PSMR Project Safety Management Representative
PEMR Environment Management Representative
PE Project Engineer
CI Civil QC Inspector


REFERENCE DOCUMENTS
Development:
J GC Detail Engineering and Design Data for Marine Facility S-900-131Z-101
Drawing - General Notes Document. No.V-31D2-001-G001
Standard - ACI 318 - 05
Standard ASTM C-94/C-94M
Standard ASTM C-70
CEP Precast Concrete Fabrication : 600-V006-2315 (V-31D2-001-A-G505)
CEP Trial Mix for Concrete Work (V-31D2-001-A-G523)
Implementation:
For Construction

APPROVAL/REVISION
Rev Date Details
Appd
(MCD)
Appd
(Client)
0 08/07/2011 Issued for Approval
1 25/07/2011 Incorporated J GC Comments
2 04/08/2011 Incorporated J GC Comments
3 16/08/2011 Incorporated J GC Comments
4 26/08/2011 Incorporated J GC Comments
5 07/09/2011 Incorporated J GC/DSLNG Comments

V-31D2-001-A-G615 Rev 5 1 of 12

INSPECTION AND TEST PLAN
Form No.
F001-017-2315


F001-017-2315 Rev 1 Page 2 of 3

Construction Process: Precast Concrete Fabri cation ITP No.: 017-W003-2315 Rev 5
Item Basic Job Step RI Acceptance Criteria
Applicable Standard and
Specification
Inspection Test Verification Activity by
Verifying Records
Method Frequency MDI JGCC DSLNG
1.0 Preparation Works

1.1
Ensure materials such as cement,
aggregates, admixture, rebar in accordance
with specification.
PQMR /
PE
Approved Material
Specifications
Detailed Engineering Design
Data For Marine Facilities
S-900-131Z-101, Section A.
ASTM C33
ASTM C260, C494
SNI 07-2052-2002 (BJ TS40)
Lab Test &
Doc
Review
Each
material
source
changed
R R R
Material Spec.
Approved, Lab. Report,
Technical Data Sheet,
Mill Certificate
1.2
Ensure reinforcement in compliance with
drawings and bending schedules
PQMR /
PE
AFC Drawing for Precast
MOF & LNG J etty,
Rebar Bending Schedule
General Notes Doc. No.
V-31D2-001-A-G001,
SNI 07-2052-2002 (BJ TS40)
Check/
Measure
Prior to
pours
concrete
I W SW
Reinforcement Checklist
017-F071-2315
1.3 Request for Inspection to the contractor PQMR
Submit to contractor by
3:00PM of the previous
working day
Field Inspection Coordination
Procedure Sec. 8
S-900-1540-001
Transmit/
Doc.
Review
Prior to
commence
the work
R R R
Notice for Inspection
(J GC Format)
1.4
Client approval for concrete mix design,
sampling and testing.
PQMR/
CM
Client Approved for Mix
Design Formula for 35 Mpa
Detailed Engineering Design
Data For Marine Facilities
S-900-131Z-101
ACI 318-05
Doc
Review /
Trial Mix
Every Trial
Mix
proposed
R R R
Concrete Test Report
017-F069-2315
1.5
Water contents for sand shall be measured
before production
PQMR/
CM
Based on lab. test result of
SSD-Saturated Surface Dry
ASTM C70,
Section 7
Lab Test &
Doc
Review
Each
material
source
changed
R R R Approved Lab. Report

1.6


Ensure formworks in accordance with
measurements of the approved drawings

PQMR /
CM
Clean, tightness, Not
leakage, dimension as AFC
drawing for MOF & LNG jetty
General Notes Doc. No.
(V-31D2-001-A-G001)
Sect. Concrete (3) Formworks
Inspection/
Record
Prior to
pours
concrete
I I SW
Formwork Checklist
017-F070-2315
2.0 Fabrication Precast Concrete

2.1
Ensure request for inspection and concrete
pre-pour inspection undertaken on each
precast production
CI / PE
Client Approval & Project
Specification, Pre-pour
inspection satisfactory
General Notes Doc. No.
(V-31D2-001-A-G001)
Inspection/
Record
As
requested
I I SW
Pre-pour Checklist
017-F006-2315
V-31D2-001-A-G615 Rev 5 2 of 12

INSPECTION AND TEST PLAN
Form No.
F001-017-2315


F001-017-2315 Rev 1 Page 3 of 3
Construction Process: Precast Concrete Fabri cation ITP No.: 017-W003-2315 Rev 5
Item Basic Job Step RI Acceptance Criteria
Applicable Standard and
Specification
Inspection Test Verification Activity by
Verifying Records
Method Frequency MDI JGCC DSLNG
2.2
Concrete supply , sampling and casting
precast unit
CI / PE
Good workability and Slump
Test (100 +20) mm
ACI 318-05
ASTM C-94/C-94M
Inspection/
Record
Each
Delivery
I I SW
Concrete Supply
Checklist
017-F072-2315
2.3
Acceptance Temperature for concrete
delivered
CI / PE
As per ASTM C94,
Subsection 11.8,
Max Temp. 32deg C
ASTM C-94/C-94M
Inspection/
Record
Each
Delivery
I I SW
Concrete Supply
Checklist
017-F072-2315
2.4
Ensure concrete placement inspection
undertaken
CI / PE
Placement inspection
satisfactory, no crack or
damage concrete
ACI 318-05
CEP Precast Concrete
Fabrication
(V-31D2-001-A-G505)
Inspection/
Record
Each
Delivery
I I SW
Concrete Placement
Checklist
017-F007-2315
2.5 Cured concrete precast SUP / CM
Keep good moist surface,
protected from rain water,
disturbance from outside
interface, applied the curing
compound

General Notes Doc. No.
V-31D2-001-A-G001

Each
precast
Prior to
Install
I I S
Concrete Curing
Checklist
017-F063-2315
2.6
Precast concrete finish and dimensional
reconfirm / check.
CI / PE Based on Approval Drawing
General Notes Doc. No.
V-31D2-001-A-G001
(V-31D2-001-A-G505)
Visual
Each
precast
I I SW
Concrete Placement
Checklist
017-F007-2315
3.0 Testing Concrete

3.1
Ensure compressive test results are
acceptable
CI / CM /
PE
Minimum Compressive
Strength is 35 Mpa at 28
Days
3 samples per each age
Relevant Specification
(J GC DEDD S-900-131Z-
101), ASTM C39, ACI 318
Comp.
Test / Lab
Every
40m
3
/Every
day
Each age
days
requested
(3, 7 & 28)
I W SW
Concrete Test Report
017-F069-2315
4.0 QUALITY RECORDS

4.1
Ensure all records are complied and
submitted / forwarded to the client
PQMR Completed Copies to Client
MDR Compilation
Specification (Equipment)
S-900-1520-003
Doc,
Transmit.
After Work
Completion
R R R
Manufacturer Data
Record (MDR)


V-31D2-001-A-G615 Rev 5 3 of 12



CONCRETE PRE-POUR CHECKLIST
Document #
017-F006-2315


017-F006-2315 Rev 1, 03 J uly 2011 Page 1 of 1
Contractor: JGC Corporation Report No.:
Project Name: Donggi Senoro LNG Project Date:
Project No.: 2315 Area:
Drawings: Location:
Reference Docs: System No.:

Inspection Activity Acceptance Inspection
Placement Y N N/A Comments
1. Survey values established
2. Checked permanent survey marks
3. Established temporary bench marks
4. Checked lines & levels
Surveyor Name: Sign: Date:

Formwork Y N N/A Comments
5. Formwork approved by MDI Civil Engineer Class of finish:
6. Material suitable for location & surface finish
7. Fillet installed to exposed edges
8. Checked location, dimensions, elevation &
alignment

9. Checked form ties, bottom bearing & propping
10. Formwork clean & release agent applied
11. Checked location of construction &
expansion joints

Voids / Inserts / Embedded Items
12. Checked type, size & number
13. Checked location, rigidity & protection
Reinforcing
14. Checked recd reinforcing & stored above ground
15. Engineers approval obtained for welding or
heating reinforcing

16. Reinforcement clean of rust & contaminants
17. Checked reinforcing for bar size, spacing,
position, stability, number & cover

18. Checked length of laps & splices

Approval to Pour: Inspected and Approval to Pour Given.
COMPANY McConnell Dowell Indonesia JGC Corporation DSLNG
SIGNATURE
NAME
DATE

V-31D2-001-A-G615 Rev 5 4 of 12

CONCRETE PLACEMENT INSPECTION
Document #.
017-F007-2315


017-F007-2315 Rev 4, 07 Sept. 2011 Page 1 of 1
Contractor: JGC Corporation Report No.:
Project Name: Donggi Senoro LNG Project Date:
Project No.: 2315 Area:
Drawing No.: System No.:

Inspection Activity Acceptance Inspection
Placement Y N N/A Comments
1. Pre-pour checklist complete &
engineers approval to pour obtained

2. Correct concrete mix ordered
Strength MPa Slump mm
3. Concrete delivery dockets checked
Docket Numbers:

Strength MPa Slump mm

4. Drop height less than 2.0m
5. No movement of formwork or reinforcing
6. No contamination
7. Concrete sample taken & recorded
8. Proper compaction equipment available
Post Pour Check
9. Type & class of finish acceptable Class of finish:
10. Ensure curing is addressed Type:
11. Existence of cracking
12. Minimum time elapsed for formwork
striking

13. No damage to finished surfaces
14. Final dimensional check / confirmation

Punch List Items Punch List/NCR
Y/N
Punch List/NCR Number
1.
2.
3.
4.
5.

COMPANY McConnell Dowell Indonesia JGC Corporation DSLNG
SIGNATURE
NAME
DATE

V-31D2-001-A-G615 Rev 5 5 of 12

CONCRETE TEST REPORT

Document #
017-F069-2315

017-F069-2315 Rev. 2, 06 J uly 2011 Page 1 of 1
Contractor: JGC Corporation Report No.:
Project Name: Donggi Senoro LNG Project Date:
Project No.: 2315 System No.:
Drawing No.: Location:
Ref. Docs: Area:

Inspection Activity
Comments Authorised
Type of concrete

Test reference no.

Company

Date cast

Type of test

Test results

7 day date/result
(Mpa)

28 day date/result
(Mpa)

Average Test Result
Comments




The above has been satisfactorily completed in accordance with
Specification and Drawing Numbers

COMPANY McConnell Dowell Indonesia JGC Corporation DSLNG
SIGNATURE
NAME
DATE

V-31D2-001-A-G615 Rev 5 6 of 12

FORMWORK CHECKLIST

Document #
017-F070-2315

017-F070-2315 Rev. 2, 06 J uly 2011 Page 1 of 2
Contractor: JGC Corporation Report No.:
Project Name: Donggi Senoro LNG Project Date:
Project No.: 2315 System No.:
Drawing No.: Ref. Docs:

Inspection Activity Acceptance Inspection
Location Comments Authorised
Material
Material checked for suitable strength and shape
Class of material suitable for location and surface
finish

Buried footings and foundations
Sawn boards, sheet metal
Buried faces of marine structure
Square edged boards
Exposed faces of all structural concrete
Lined formwork for smooth finish
Uniform appearance
Joints
Formwork joints to form regular pattern
(horizontal/vertical lines)

Splays 25mm x 25mm installed on all internal and
external angles of formwork where required

J oints checked for mortar tightness
Formwork below or between tides caulked to
prevent ingress of water

Dimensions
Check formwork for the following to specified
tolerance

Location
Dimension
Elevation
Alignment
Stability
Check for construction load and impact
Strength of form plate
Interval of form ties
Interval and bottom bearing of shoring
Other means of support
Overlapping to previous pour where
required

V-31D2-001-A-G615 Rev 5 7 of 12

FORMWORK CHECKLIST

Document #
017-F070-2315

017-F070-2315 Rev. 2, 06 J uly 2011 Page 2 of 2

Voids/Inserts/Embedded Items
Checked inserts, anchor bolts, void formers for
correct

Type
Size
Number
Location, direction and elevation to
tolerance

Rigidity and support to prevent movement
or damage during pour

Fixing to reinforcement where specified
Protection of anchor bolt threads
Drain holes provided in hollow void formers
Sealed or made grout tight inserts to which fittings
are to be later attached

Prior to Pour
Formwork cleaned free of debris
Release agent applied to inside surface
Formwork approved by Engineer


COMPANY McConnell Dowell Indonesia JGC Corporation DSLNG
SIGNATURE
NAME
DATE

V-31D2-001-A-G615 Rev 5 8 of 12

REINFORCEMENT CHECKLIST
Document #
017-F071-2315

017-F071-2315 Rev. 2, 04 J uly 2011 Page 1 of 1
Contractor: JGC Corporation Report No.:
Project Name: Donggi Senoro LNG Project Date:
Project No.: 2315 System No.:
Drawing No.: Ref Docs:

Inspection Activity Acceptance Inspection
Location : Comments Authorised
Material
Incoming reinforcement checked for correct
Shape
Size
Type
Test certificates
Identification/Tags
Location
Checked incoming type wire for correct type and size
Storage
Reinforcement stored above ground, under
waterproof shelter

Fixing Reinforcement
Checked that bars to be hot bent are not cold worked
type

Engineers approval obtained for welding mild steel
rebar

Reinforcement cleaned of loose mill scale, rust, oil,
grease, etc

Checked placed reinforcing bars, ties, links, stirrups,
spacers for correct

Number
Size
Form
Position
Stability
Cover
Checked length of laps and splices
Reinforcement projecting above the lift being cast is
fixed to prevent movement during pour



COMPANY McConnell Dowell Indonesia JGC Corporation DSLNG
SIGNATURE
NAME
DATE
V-31D2-001-A-G615 Rev 5 9 of 12

CONCRETE SUPPLY CHECKLIST
Document #
017-F072-2315

017-F072-2315 Rev. 1, 04 J uly 2011 Page 1 of 2
Contractor: Report No.:
Project Name: Date:
Project No.: System No.:
Ref. Docs.: Location:

Inspection Activity Acceptance Inspection
Location Comments Authorised
Ready mix plant certified
Concrete Mix Design
Concrete conforms to specified 28 day strength
Mix design approved by Engineer
Trial mix tested to specification
Cement
Test certificates received for each assignment
Cement stored in silos or bags to
Prevent contamination
Maintain freshness
Allow identification of lots
Aggregates
Aggregates tested to verify conformance to client
specification

Storage and handling to prevent
Contamination
Segregation
Aggregate tested during production
Water
Tested to client specification
Admixtures
Approved by client
Batching and Mixing
Check batching and mixing plant is adequate
(including backup)

Weighing facilities (capacity, accuracy)
Transport facilities
Mixer (capacity, rotating velocity)
Control system
Truck mixer (capacity mixing)
Time of transportation to job site
V-31D2-001-A-G615 Rev 5 10 of 12

CONCRETE SUPPLY CHECKLIST
Document #
017-F072-2315

017-F072-2315 Rev. 1, 04 J uly 2011 Page 2 of 2

Check the following during batching
Moisture content of aggregate, and
adjustment of volume of mix water

Type and grade of material
Temperature of aggregates, cement and
water

Concrete Temperature
Ambient Temperature
Material thoroughly mixed dry
Batching accuracy
Concrete batch notes
Check during mixing
Mixing time
No overloading
Mixing plant thoroughly cleaned


COMPANY McConnell Dowell Indonesia JGC Corporation DSLNG
SIGNATURE
NAME
DATE

V-31D2-001-A-G615 Rev 5 11 of 12
NO. :
PROJECT : DS-LNG Marine Work / 2315
DATE :
LOCATION :
NO. F'c Qty. TIME BATCH TIME AT SITE CUMM. Qty.
NO. :
PROJECT : DS-LNG Marine Work / 2315
DATE :
LOCATION :
NO. F'c Qty. TIME BATCH TIME AT SITE CUMM. Qty.
NO. :
PROJECT : DS-LNG Marine Work / 2315
DATE :
LOCATION :
NO. F'c Qty. TIME BATCH TIME AT SITE REMARKS
Checked By, Approved By,
CONCRETE ORDER SHEET
of BATCHING PLANT
FOUNDATION ITEM
Received By,
Received By,
CONCRETE ORDER SHEET
of BATCHING PLANT
FOUNDATION ITEM
Checked By, Approved By,
Approved By, Received By,
Prepared By,
Prepared By,
Prepared By, Checked By,
CONCRETE ORDER SHEET
of BATCHING PLANT
FOUNDATION ITEM
V-31D2-001-A-G615 Rev 5 12 of 12