IAM Form - Delivering Projects

MATERIAL SUBMITTAL FORM (FRONT COVER SHEET)

Division Office / Project: EVOTY INDONESIA MOTOPLANT

Project No.: ID238 Date: 22-Sep-14
Material submitted for Reviewed:
Demag Cranes
Location / Area: Finished Product Initiator: Erwin Handayani
Spec Ref / Drg Nos.: Key Word:
Discipline: Civil Structural Architectural E&I Mech Other (specify)

Document No. Rev Title of Document Review by Date

LCI-S-SB-ZZ-0023 Demag Cranes for Finished Product

Signed: Signed (Recipient):

Name: Erwin Handayani Name:
Please sign copy and return to sender Date Received:

CLIENT / CONSULTANT RESPONSE

FROM:
NAME:
Reviewed wih no objection - (use as is)
Reviewed with comments - (incorporate or implement the comment, then proceed. Further re-submittal may be
required, if specified)
Rejected - (resolve the unacceptable condition as per the noted comments and resubmit before proceeding
Reviewed
Comments:

Signed: Date:
Name:

Indonesia Asia Mining

IAM-DEP-FRM-115 Rev 02 Page 1 of 1
12 February 2014