INSPECTION AND TEST PLAN Form No.

: FM-QA-QC-11
Rev. : 00

EMK PIPING FABRICATION AND INSTALLATION

PT. EPITERMA MAS KONSTRUKSI
Delta Silicon 2 Blok F18 No. 007 JI. Cempaka – Cikarang Pusat, Lippo Cikarang – Indonesia 17550
Date

Page
: 05-01-2015

: 1 of 7
(62 21) 8990 7056 Fax (62 21) 89900133
PROJECT : SMP UTILITIES LAMPUNUT PROJECT Doc No. PTMC02-DD-0009c PREPARED DATE REVIEWED DATE APPROVED DATE REV
CUSTOMER : PT. MARUWAI COAL PO No. B08-PC0619-000000003 Hulman. P 06/05/19 MDM 06/05/19 4

ACTIONS : H= HOLD W = WITNESS M = MONITOR R = REVIEW A = APPROVE SM = SUBMIT I = INSPECT

RESPONSIBILITY : QA/QC = QUALITY ASSURANCE/QUALITY CONTROL E = ENGINEERING WH= WAREHOUSE PM = PROJECT MANAGER SC=SITE CONSTRUCTION PRD=PRODUCTION
rd
DESCRIPTION OF PROCESS AND CONTROL ACCEPTANCE CERTIFY – VERIFY PT. EMK PT. MC 3 Party Drawing
No RESP.
INSPECTION ACTIVITY DOCUMENT CRITERIA Reff
DOCUMENT MDR ACT SIGN ACT SIGN ACT SIGN

1.0 PROJECT DOCUMENTATION AND DRAWING

Document Approved
1.1 Check design drawing E Project Spec Yes SM R
Transmittal drawing
Document Approved
1.2 Check Piping GA Drawing E Project Spec Yes SM R
Transmittal drawing
Check Isometric drawing and Ensure Document Approved
1.3 E Project Spec Yes SM R
Heat No. Transmittal drawing
Document Approved
1.4 WPS / PQR QA/QC ASME SECT IX Yes SM R
Transmittal WPS/PQR
Document Approved
1.5 Welder Certificate + WI Certificate QA/QC ASME SECT IX Yes SM R
Transmittal Certificate
NDE Procedure and Personnel Document ASME SECT V, Approved
1.6 QA/QC Yes SM R
Certificate Transmittal SNT TC-1A Procedure
SC, Document 17037-P4-P-0A1G- Approved
1.8 Hydrotest Test Procedure Yes SM R
QA/QC Transmittal SZ-00002_0 Procedure
SC, Document 17037-P4-P-0A1G- Approved
1.9 Erection & Installation Procedure Yes SM R
QA/QC Transmittal SZ-00002_0 Procedure
SC, Document 17037-P4-P-0A1G- Approved
1.10 Degreasing application Procedure Yes
QA/QC Transmittal SZ-00002_0 Procedure
Surface treatment, painting and pickling SC, Document 17037-P4-P-0A1G- Approved
1.11 Yes SM R
application QA/QC Transmittal SZ-00002_0 Procedure

2.0 TOOLS AND MATERIALS PREPARATION

Material
Material Inspection
WH, -17037-P4-P-0A1G- Inspection
2.1 (Check Heat number and Mills Epiterma PO Yes H W
QA/QC SZ-00001 Report, Mill
certificate)
-AS 4041 Certificate
 INSPECTION AND TEST PLAN Form No. : FM-QA-QC-11
Rev. : 00

EMK PIPING FABRICATION AND INSTALLATION

PT. EPITERMA MAS KONSTRUKSI
Delta Silicon 2 Blok F18 No. 007 JI. Cempaka – Cikarang Pusat, Lippo Cikarang – Indonesia 17550
Date

Page
: 05-01-2015

: 2 of 7
(62 21) 8990 7056 Fax (62 21) 89900133
PROJECT : SMP UTILITIES LAMPUNUT PROJECT Doc No. PTMC02-DD-0009c PREPARED DATE REVIEWED DATE APPROVED DATE REV
CUSTOMER : PT. MARUWAI COAL PO No. B08-PC0619-000000003 Hulman. P 06/05/19 MDM 06/05/19 4

ACTIONS : H= HOLD W = WITNESS M = MONITOR R = REVIEW A = APPROVE SM = SUBMIT I = INSPECT

RESPONSIBILITY : QA/QC = QUALITY ASSURANCE/QUALITY CONTROL E = ENGINEERING WH= WAREHOUSE PM = PROJECT MANAGER SC=SITE CONSTRUCTION PRD=PRODUCTION
rd
DESCRIPTION OF PROCESS AND CONTROL ACCEPTANCE CERTIFY – VERIFY PT. EMK PT. MC 3 Party Drawing
No RESP.
INSPECTION ACTIVITY DOCUMENT CRITERIA Reff
DOCUMENT MDR ACT SIGN ACT SIGN ACT SIGN

-AS 4041
-AWS A5.1
-AWS A5.36
Handling & Storage Welding WH, Epiterma PO,
2.3 -AWS A5.4 -Mills Cert Yes H R
Consumable QA/QC ASME II Sect-C
-AWS A5.9
- 17037-P4-P-0A1G-
SZ-00002
3.0 SHOP AND SITE FABRICATION
Dimensional
PRD - 17037-P4-P-0A1G-
3.1 Pre-Fabrication and Cuting Shop Drawing Inspection Yes H R
QA/QC SZ-00002
Report
-Spool traceability check Dimensional
PRD - 17037-P4-P-0A1G-
3.2 -Dimension check Shop Drawing Inspection Yes H R
QA/QC SZ-00002
-Piping Label, Joint Numbering Report
4.0 WELDING
Approved
WPS/PQR - ASME Sect. IX
Select the suitable WPS , PQR and WPS/PQR/WQR
4.1 QA/QC Approved - 17037-P4-P-0A1G- Yes H R
Welder Qualification Records List
WPQR SZ-00002
QP-S-003
- ASME Sect. IX Welder
Verify Welder ID, welding consumable WPS List,
4.2 QA/QC - 17037-P4-P-0A1G- Certificate, Yes H R
and welding process Welder List
WPS/PQR
SZ-00002
Stainless Steel:
-Check welding electrode and dry Electrode
condition certificate, fit-up
-Check Shielding Gas and Flow rate -ASME Sect. IX and welding
SC Erection
4.3 -Pipe top level check - 17037-P4-P-0A1G- report, welder Yes H R
QA/QC Drawing
-Fit-up and edge preparation correct gap SZ-00002 list and
-Marking of welder ID number and joint certificate and
Number, weld date WPS/PQR
-Ensure Argon purity (99,99%)
 INSPECTION AND TEST PLAN Form No. : FM-QA-QC-11
Rev. : 00

EMK PIPING FABRICATION AND INSTALLATION

PT. EPITERMA MAS KONSTRUKSI
Delta Silicon 2 Blok F18 No. 007 JI. Cempaka – Cikarang Pusat, Lippo Cikarang – Indonesia 17550
Date

Page
: 05-01-2015

: 3 of 7
(62 21) 8990 7056 Fax (62 21) 89900133
PROJECT : SMP UTILITIES LAMPUNUT PROJECT Doc No. PTMC02-DD-0009c PREPARED DATE REVIEWED DATE APPROVED DATE REV
CUSTOMER : PT. MARUWAI COAL PO No. B08-PC0619-000000003 Hulman. P 06/05/19 MDM 06/05/19 4

ACTIONS : H= HOLD W = WITNESS M = MONITOR R = REVIEW A = APPROVE SM = SUBMIT I = INSPECT

RESPONSIBILITY : QA/QC = QUALITY ASSURANCE/QUALITY CONTROL E = ENGINEERING WH= WAREHOUSE PM = PROJECT MANAGER SC=SITE CONSTRUCTION PRD=PRODUCTION
rd
DESCRIPTION OF PROCESS AND CONTROL ACCEPTANCE CERTIFY – VERIFY PT. EMK PT. MC 3 Party Drawing
No RESP.
INSPECTION ACTIVITY DOCUMENT CRITERIA Reff
DOCUMENT MDR ACT SIGN ACT SIGN ACT SIGN

Carbon Steel:
Electrode
-Check welding electrode and dry
certificate, fit-up
condition
and welding
-Pipe top level check SC Erection - 17037-P4-P-0A1G-
4.4 report, welder Yes H R
-Fit-up and edge preparation correct QA/QC Drawing SZ-00002
list and
Gap
certificate,
-Marking of welder ID number, joint
WPS/PQR
number and weld date
HDPE :
-Fit-up and edge preparation
-Check Facing preparation
-Check Straightening preparation Fit-up and
- 17037-P4-P-0A1G-
-Check Heating Element welding report,
SC Erection SZ-00002
4.5 -Check melting joint & Cooling welder list and Yes H R
QA/QC Drawing - 17037-P4-P-0A1G-
-Marking joint No. & Welding date certificate,
SZ-00004
-Test Result for each PN from WPS
laboratory anlisys and Testing
-Tensile strenght and flexural beam
testing in every 50 Joints
Verify Weld acceptability Welding
100% Visual Inspection. Erection - 17037-P4-P-0A1G- Inspection
4.6 10% Penetrant Test. (for Carbon Steel QA/QC Drawing, NDT Report, Welding Yes H R
Plan SZ-00002 & NDE MAP and
and Stainless Steel material)
RT if Any NDT Report
Welding
Erection - 17037-P4-P-0A1G-
Verify that all NDE requirement each line Inspection
4.7 QA/QC Drawing, NDT Yes H R
service have obtained properly. SZ-00002 Report, NDT
Plan
Report
5.0 PIPELINE PREPARATION (Above and Under Ground Pipe)
Piping
Check the pipe line with the actual Installation
SC Erection - 17037-P4-P-0A1G-
5.1 situations as per P&ID& piping General Check List/ Yes H R
QA/QC Drawing SZ-00002
arrangement drawing Piping Line
Check
 INSPECTION AND TEST PLAN Form No. : FM-QA-QC-11
Rev. : 00

EMK PIPING FABRICATION AND INSTALLATION

PT. EPITERMA MAS KONSTRUKSI
Delta Silicon 2 Blok F18 No. 007 JI. Cempaka – Cikarang Pusat, Lippo Cikarang – Indonesia 17550
Date

Page
: 05-01-2015

: 4 of 7
(62 21) 8990 7056 Fax (62 21) 89900133
PROJECT : SMP UTILITIES LAMPUNUT PROJECT Doc No. PTMC02-DD-0009c PREPARED DATE REVIEWED DATE APPROVED DATE REV
CUSTOMER : PT. MARUWAI COAL PO No. B08-PC0619-000000003 Hulman. P 06/05/19 MDM 06/05/19 4

ACTIONS : H= HOLD W = WITNESS M = MONITOR R = REVIEW A = APPROVE SM = SUBMIT I = INSPECT

RESPONSIBILITY : QA/QC = QUALITY ASSURANCE/QUALITY CONTROL E = ENGINEERING WH= WAREHOUSE PM = PROJECT MANAGER SC=SITE CONSTRUCTION PRD=PRODUCTION
rd
DESCRIPTION OF PROCESS AND CONTROL ACCEPTANCE CERTIFY – VERIFY PT. EMK PT. MC 3 Party Drawing
No RESP.
INSPECTION ACTIVITY DOCUMENT CRITERIA Reff
DOCUMENT MDR ACT SIGN ACT SIGN ACT SIGN

Piping Design Piping

Check the pipe line with the actual Drawing - 17037-P4-P-0A1G- Installation
5.2 SC Yes H R
situations Isometric & SZ-00002 Check List, GA
drawing P&ID Drawing
Piping
Piping Design
Installation
DrawingIsometri - 17037-P4-P-0A1G-
5.3 Make sure marking of pipe is correctly SC Check List, Yes H R
c & drawing SZ-00002
Isometric
P&ID
drawing
Piping Design Piping
Make sure pipe not cross steel structure Drawing - 17037-P4-P-0A1G- Installation
5.4 SC Yes H R
and mechanical or electrical. Isometric & SZ-00002 Check List, GA
drawing P&ID drawing
Piping
Piping Design
Installation
Make sure pipe support already installed Drawing - 17037-P4-P-0A1G-
5.5 SC Check List, P/S Yes H R
properly, and accordance to the spec Isometric & SZ-00002
standard
drawing P&ID drawing
Piping
Piping Design
Make sure if installed flange free Installation
Drawing - 17037-P4-P-0A1G-
5.6 demage at area face flange and make SC Check List, Yes H R
Isometric & SZ-00002
sure they are installed without stress Isometric
drawing P&ID drawing
Piping Design Piping
Make sure if installed of valve in Drawing - 17037-P4-P-0A1G- Installation
5.7 SC Yes H R
accordance with P&ID , Class and type Isometric & SZ-00002 Check List,
drawing P&ID P&ID

6.0 PIPING INSTALLATIONS

Piping Design
Drawing Piping
Install pipe same as pipe lines directions - 17037-P4-P-0A1G-
6.1 SC Installation Yes H R
as per P&ID, GA and Isometric Isometric & SZ-00002
Check List
drawing P&ID
 INSPECTION AND TEST PLAN Form No. : FM-QA-QC-11
Rev. : 00

EMK PIPING FABRICATION AND INSTALLATION

PT. EPITERMA MAS KONSTRUKSI
Delta Silicon 2 Blok F18 No. 007 JI. Cempaka – Cikarang Pusat, Lippo Cikarang – Indonesia 17550
Date

Page
: 05-01-2015

: 5 of 7
(62 21) 8990 7056 Fax (62 21) 89900133
PROJECT : SMP UTILITIES LAMPUNUT PROJECT Doc No. PTMC02-DD-0009c PREPARED DATE REVIEWED DATE APPROVED DATE REV
CUSTOMER : PT. MARUWAI COAL PO No. B08-PC0619-000000003 Hulman. P 06/05/19 MDM 06/05/19 4

ACTIONS : H= HOLD W = WITNESS M = MONITOR R = REVIEW A = APPROVE SM = SUBMIT I = INSPECT

RESPONSIBILITY : QA/QC = QUALITY ASSURANCE/QUALITY CONTROL E = ENGINEERING WH= WAREHOUSE PM = PROJECT MANAGER SC=SITE CONSTRUCTION PRD=PRODUCTION
rd
DESCRIPTION OF PROCESS AND CONTROL ACCEPTANCE CERTIFY – VERIFY PT. EMK PT. MC 3 Party Drawing
No RESP.
INSPECTION ACTIVITY DOCUMENT CRITERIA Reff
DOCUMENT MDR ACT SIGN ACT SIGN ACT SIGN

Piping Design
Drawing Piping
Make sure all pipe free from contaminant - 17037-P4-P-0A1G-
6.2 SC Installation Yes H R
carbon material (Only Stainless Steel) Isometric & SZ-00002
Check List
drawing P&ID

Piping Design
Drawing Piping
Make sure all connected pipe already tie - 17037-P4-P-0A1G-
6.3 SC Installation Yes H R
up or full weld Isometric & SZ-00002
Check List
drawing P&ID

Piping Design
Check internal cleaness for pipe Drawing Piping
- 17037-P4-P-0A1G-
6.4 SC Installation Yes H R
Debris,left over tool material Isometric & SZ-00002
Check List
drawing P&ID

Piping Design
Drawing Piping
- 17037-P4-P-0A1G-
6.5 Make sure U Bolt has been installed SC Installation Yes H R
Isometric & SZ-00002
Check List
drawing P&ID
Piping Design
Drawing Piping
Make sure if installed of valve in - 17037-P4-P-0A1G-
6.6 SC Installation Yes H R
accordance with P&ID Isometric & SZ-00002
Check List
drawing P&ID

7.0 HYDROTEST AND DEGREASING PIPE

Erection - 17037-P4-P-0A1G-
SC NDT Clearance
7.1 Ensure NDE Clearance is Completed Drawing, NDT Yes H H
QA/QC SZ-00002 Report
Plan
Hydrotest report,
SC Hydrotest - 17037-P4-P-0A1G-
7.2 Hydrotest Calibration Yes H R/A/I
QA/QC Procedure SZ-00002
Certificate
 INSPECTION AND TEST PLAN Form No. : FM-QA-QC-11
Rev. : 00

EMK PIPING FABRICATION AND INSTALLATION

PT. EPITERMA MAS KONSTRUKSI
Delta Silicon 2 Blok F18 No. 007 JI. Cempaka – Cikarang Pusat, Lippo Cikarang – Indonesia 17550
Date

Page
: 05-01-2015

: 6 of 7
(62 21) 8990 7056 Fax (62 21) 89900133
PROJECT : SMP UTILITIES LAMPUNUT PROJECT Doc No. PTMC02-DD-0009c PREPARED DATE REVIEWED DATE APPROVED DATE REV
CUSTOMER : PT. MARUWAI COAL PO No. B08-PC0619-000000003 Hulman. P 06/05/19 MDM 06/05/19 4

ACTIONS : H= HOLD W = WITNESS M = MONITOR R = REVIEW A = APPROVE SM = SUBMIT I = INSPECT

RESPONSIBILITY : QA/QC = QUALITY ASSURANCE/QUALITY CONTROL E = ENGINEERING WH= WAREHOUSE PM = PROJECT MANAGER SC=SITE CONSTRUCTION PRD=PRODUCTION
rd
DESCRIPTION OF PROCESS AND CONTROL ACCEPTANCE CERTIFY – VERIFY PT. EMK PT. MC 3 Party Drawing
No RESP.
INSPECTION ACTIVITY DOCUMENT CRITERIA Reff
DOCUMENT MDR ACT SIGN ACT SIGN ACT SIGN

SC Flusing - 17037-P4-P-0A1G-
7.3 Flushing line Inspection report Yes H R/I/A
QA/QC Procedure SZ-00002

SC Flusing - 17037-P4-P-0A1G-
7.4 Degreasing (Only SS) Inspection report Yes H R/I/A
QA/QC Procedure SZ-00002

8.0 SURFACE TREATMENT, PAINTING, PICKLING AND LINING (If Any)

Check weather condition include air
Painting - 17037-P4-G-0A1A-
8.1 temperature, wet bulb, dry bulb, QA/QC Procedure SZ-00002_0
Inspection report Yes H R
humidity and dew point
Check Surface Appearance After
Blasting (in Fabrication/Workshop):
Painting - 17037-P4-G-0A1A-
8.2 o Surface Appearance – SA 2.5 QA/QC Inspection report Yes H R
Procedure SZ-00002_0
o Surface roughness – 40 – 70 m or
as per paint data sheet

Check Paint consummable (batch no & Painting - 17037-P4-G-0A1A-

8.3 QA/QC Procedure SZ-00002_0
Inspection report Yes H R
expired date)

Check All surface shall be cleaned from Painting - 17037-P4-G-0A1A-

8.4 QA/QC Inspection report Yes H R
dust, rust prior painting Procedure SZ-00002_0

Check DFT from Primer Coat until Top Painting - 17037-P4-G-0A1A-

8.5 QA/QC Procedure SZ-00002_0
Inspection report Yes H R
Coat

9.0 PICKLING AND LINING (If Any)

All surface shall be cleaned from dust,
spatter and oil before Pickling Pickling - 17037-P4-G-0A1A-
9.1 QA/QC Inspection report Yes H R
application (only for Stainless Steel) Procedure SZ-00002_0
 INSPECTION AND TEST PLAN Form No. : FM-QA-QC-11
Rev. : 00

EMK PIPING FABRICATION AND INSTALLATION

PT. EPITERMA MAS KONSTRUKSI
Delta Silicon 2 Blok F18 No. 007 JI. Cempaka – Cikarang Pusat, Lippo Cikarang – Indonesia 17550
Date

Page
: 05-01-2015

: 7 of 7
(62 21) 8990 7056 Fax (62 21) 89900133
PROJECT : SMP UTILITIES LAMPUNUT PROJECT Doc No. PTMC02-DD-0009c PREPARED DATE REVIEWED DATE APPROVED DATE REV
CUSTOMER : PT. MARUWAI COAL PO No. B08-PC0619-000000003 Hulman. P 06/05/19 MDM 06/05/19 4

ACTIONS : H= HOLD W = WITNESS M = MONITOR R = REVIEW A = APPROVE SM = SUBMIT I = INSPECT

RESPONSIBILITY : QA/QC = QUALITY ASSURANCE/QUALITY CONTROL E = ENGINEERING WH= WAREHOUSE PM = PROJECT MANAGER SC=SITE CONSTRUCTION PRD=PRODUCTION
rd
DESCRIPTION OF PROCESS AND CONTROL ACCEPTANCE CERTIFY – VERIFY PT. EMK PT. MC 3 Party Drawing
No RESP.
INSPECTION ACTIVITY DOCUMENT CRITERIA Reff
DOCUMENT MDR ACT SIGN ACT SIGN ACT SIGN

10.0 MANUFACTURER DATA REPORT (MDR)

Compile all reports at MDR (include

10.1 QA/QC MDR Index MDR Index MDR - SM A
signed ITP)

1(one) electronic
10.2 Submit to client approved MDR QA/QC Completed MDR MDR Index Copy and 1(one) - SM A
Hard Copy

PT. EMK PT. EMK PT. MC

Prepared by Reviewed by Approved by

Signature Signature Signature

Name : Hulman Purba Name : Murdono Name :

Date : 06 May 2019 Date : 06 May 2019 Date :

 Form No. Formulir : FM‐QA/QC‐49
Revision No. : 00

EMK Material Receiving Inspection Report (MRIR) Date of 

Issued
:
Page No. : 1 of 1

Material Receiving Inspection Report Report No  '...../PRJ /MRIR/EMK/Month/Year

Material Report for Urgent Release Date 
Excess Material Inspection Report

Supplier :
Division :
Project No :
Project Name :

Purchase : Local Impor

Goods 
No Description Qty Unit Spec Heat/Batch No. Mill Certificate. No Comply/No Remarks
Code

TOTAL
Remarks :

Prepared by,                                                        Checked by,                                                 Approved by,

(  Logistic  )               (QA/QC Inspector/Engineer)          (     Client Reps            )