PT.

AMBERCYCLE ADVANCED MATERIALS INDONESIA

AMBERCYCLE POLYETHYLENE TEREPHTHALATE (PET) PROJECT

CONSTRUCTION QC PROSEDURE / GENERAL

FIELD INSPECTION NOTICE

FIN No. : DATE :

SUBCONT NAME :
CONTRACT NO. :

DISIPLINE :

ATTN :

SUBJECT :

Dear Sirs,
You are kindly requested to witness the following inspection (s) and / or test (s).

INSPECTION AREA TIME INSPECTOR WITNESSING

REMARKS
AUTHORITY
DISCIPLINE DESCRIPTION GRADE / LOCATION START DURATION IKPT IKI
PRESENCE

Note :

Yours Faithfully,

Head of Quality Control

 ITP NO. :
INSPECTION Gr. :
FIELD INSPECTION REPORT REPORT NO. :
DATE :

INSPECTION TYPE: WORK No. :

LABORATORY / MATERIAL TEST CERTIFICATE ITEM No. :
(Civil Works) AREA / LOCATION :
ITEM No. DESCRIPTION: SIGNATURE
INSPECTION NOTICE No. OWNER CONTRACTOR SUBCONT
OWNER’S INSPECTOR / / / / / /
CONTRACTOR’S INSPECTOR
SUBCONT’S INSPECTOR
WORK SCOPE
Site Preparation Piling
Road and Paving Drainage
Earth Work Fence and Gate
Concrete Structural Steel
Building Landscape
Other Material :

ATTACHMENT LIST
No. Item / Material / Sample Laboratory / Supplier Remarks
1
2
3
4
5
6
7
8
9
10
Comments:

LEGEND ACC : ACCEPT N.A. : Not Applicable REJ : REJECT DWG : DRAWING

FORM No. GC-001

 ITP NO. :
INSPECTION Gr. :
FIELD INSPECTION REPORT REPORT NO. :
DATE :

INSPECTION TYPE: WORK No. :

DENSITY TEST ITEM No. :
(IN-SITU) AREA / LOCATION :
ITEM No. DESCRIPTION: SIGNATURE
INSPECTION NOTICE No. OWNER CONTRACTOR SUBCONT
OWNER’S INSPECTOR / / / / / /
CONTRACTOR’S INSPECTOR
SUBCONT’S INSPECTOR

1) TYPE OF TEST

2) OPT. MOISTURE CONTENT WOPT (%)

3) MAX. DRY DENSITY γ dMAX (g/cm3)

As per Dwg. or
4) TARGET DRY DENSITY (%) – Project Specs

DENSITY TEST RESULTS

AREA/ ITEM / MOISTURE γd

SAMPLE TYPE OF DRY DENSITY × 100 (%) ACC /
COORDINATE / CONTENT γ d MAX
No. SAMPLE γ d (g/cm3) REJ
DRAWING No. W (%)

REMARKS:

LEGEND ACC : ACCEPT N.A. : Not Applicable REJ : REJECT

FORM NO. C-002

 AMBERCYCLE POLYTHLENE
TEREPHTHALATE (PET)
Subject : SAND CONE TEST RECORD - ASTM D 1556 / SNI 2828 Project No : date :
Project : Ambercycle Polythlene Terephthalate (PET) System/Subsystem
:
No.
Client : PT. AMBERCYCLE Weather :
Location : Ref .Draw : Rev.:
Layer : Test by : /

Bottle
No Description Unit
A B C
1 Test point
2 Sand cone apparatus No.
3 Test Point No 1 of 1
4 Weight of bottle + cone a gr
5 Weight of full water in bottle + cone b gr
6 Weight of full sand in bottle + cone c gr
7 Weight of sand in bottle sufficiently + cone d gr
8 Weight of remaining sand in bottle + cone e gr
9 Weight of sand + bottle + cone W1 gr
10 Weight of remaining sand + bottle + cone W2 gr
11 Weight of sand in cone + plate + hole W3 = W1 - W2 gr -
12 Weight of sand in cone W4 = d - e gr -
13 Weight of sand in hole W5 = W3 - W4 gr
14 Density of sand (gr) gr = (c - a)/(b - a) gr/cm3
15 Volume of hole = volume of soil V = W5/gr cm3
16 Weight of soil + tare W6 gr
17 Weight of tare W7 gr
18 Weight of wet soil W8 = W6 - W7 gr
19 Density of wet soil (gt) gt = W8 / V cm3
20 Water content (w) W %
21 Field dry density (gd field ) gdfield = gt*100/100+w gr/cm3
22 Lab dry density (gd lab) gd Lab gr/cm3
23 Degree of compaction D = gdfield*100/gd Lab %
24 Average degree of compaction %
25 Required percent of compaction %

* Note:
1. Specification of density : 95 %
No Test No Test Result

1 Point No.1 Accepted Rejected

2 Point No.2 Accepted Rejected

3 Point No.3 Accepted Rejected

Remarks :

SUBCONTRACTOR CONTRACTOR CONSULTANT / OWNER

Print Name

Signature

Date
 ITP NO. :
INSPECTION Gr. :
FIELD INSPECTION REPORT REPORT NO. :
DATE :

INSPECTION TYPE: WORK No. :

BACKFILLING INSPECTION ITEM No. :
AREA / LOCATION :
ITEM No. DESCRIPTION: SIGNATURE
INSPECTION NOTICE No. OWNER CONTRACTOR SUBCONT
OWNER’S INSPECTOR / / / / / /
CONTRACTOR’S INSPECTOR
SUBCONT’S INSPECTOR
INSPECTIONS ACC REJ N/A REMARKS
A. PREPARATION
1. Fill material is clean and conforms to requirement?
2. Area to be backfilled if clear of water, trash, and other foreign
debris?

B. DURING BACKFILLING/COMPACTION
1. Moisture control is properly carried-out as per current weather
condition?
2. Fill and backfill layer (lift thickness) are uniformly compacted?
3. Fill and backfill in areas adjacent to structure, facility, piping,
etc. are compacted as per requirement?
4. Compaction equipment used is suitable to the entire lift and
fill material being compacted?

C. FINAL CHECK
1. Final elevation or compacted surface graded to the elevation
and configuration as per related drawing?
2. Soil Density Test performed as required? (Note: Ref. FIR C-002)

COMMENTS

LEGEND ACC : ACCEPT N.A. : Not Applicable REJ : REJECT

FORM NO. C-017

 ITP NO. :
INSPECTION Gr. :
REPORT NO. :
FIELD INSPECTION REPORT
DATE :

INSPECTION TYPE: WORK NO. :

ITEM NO. :
LOCATION :
SIGNATURE
INSPECTION NOTICE NO. : OWNER CONTRACTOR SUBCONT
OWNER’S INSPECTOR : / / / / / /
CONTRACTOR’S INSPECTOR :
SUBCONT’S INSPECTOR :

LEGEND N.A. : Not Applicable

FORM NO. G-001