Inspection Release Certificate

Refinery Development Master Plan (RDMP) Project

RDMP-26071-100-POA-JL11-
IRC Number Date of Issue 28th June, 2023
00001-IRC-0010

Refinery Development Master

Project Name Vendor Name KOFAC
Plan (RDMP) Project

Level Instrument
PO Number 26071-100-POA-JL11-00001 PO Description
(Displacer type) (HCU)

Item Number Item Description Quantity Remarks

- 0Y0873X0082_GASKET ~ 4.56X5.23X.03 1 pcs

- 1E5629X0072_GASKET ~ 2.00X2.50X.03 1 pcs
- 1K4515000A2_TORQUE TUBE ASSY 1 pcs
Refer to the
- GE93321X012_DISPLACER 3X14.17 1 pcs
Packing List
- R249BX00012_KIT,REPAIR ~ 249B AND 259B SPARES 1 pcs
- R2500F00012_KIT,REPAIR ~ 2500-249 HEAT INSULATOR 1 pcs
- DLC3100_DLC-3964-5818706 1 pcs
Total: 7 pcs

Total Partial

Condition
No remaining(open) NCR.
All documents related inspection have been approved.
Packing list has been reviewed by RDMP JO.
Condition: N/A.

Attachment
#1. Packing List
#2. Certificate Of Conformity.

Issued by RDMP JO

Andry Arifin
Name/Signature: Dong-Keun, Lee
JO QA/QC Manager

WE HEREBY CERTIFY THAT ABOVE MENTIONED COMMODITY HAS SATISFACTORILY PASSED

THE TEST & INSPECTION IN ACCORDANCE WITH THE CONTRACTUAL SPECIFICATION.
HOWEVER, THIS CERTIFICATE DOES NOT RELIEVE VENDOR FROM THE GUARANTEES AND
OBLIGATIONS WHICH ARE SET FORTH IN THE PURCHASE ORDER AND ATTACHMENTS.
 PACKING LIST
PAGE NO.: 1 OF 2
① Shipper / Exporter ⑧ No. & date of invoice
Emerson Asia Pacific Private Limited 0 DATE : 2023-06-15
No. 1 Pandan Crescent ⑨ Remarks
Singapore 128461
② Consignee * FINAL DESTINATION :
PT. KILANG PERTAMINA BALIKPAPAN - RDMP RU-V BALIKPAPAN PROJECT, INDONESIA
GEDUNG UTAMA PERTAMINA LT. 14
JL. MEDAN MERDEKA TIMUR NO.1A * MANUFACTURER'S FULL NAME AND ADDRESS :
KEL. GAMBIR, KEC.GAMBIR Emerson Asia Pacific Private Limited
JAKARTA PUSAT - INDONESIA No. 1 Pandan Crescent
NPWP NO: 92.072.048.9-025.000 Singapore 128461
③ Notify party
1) RDMP Balikpapan JO
Jl. Bongas I , Karang Jati, Balikpapan Tengah
Kota Balikpapan, Kalimantan Timur 76123
2) PT F.H. Bertling Logistics
The East Building 36th Floor – Unit 07
Jl.DR Ide Anak Agung Gde Agung Kav.3.2 No. 1
Kuningan Timur – Setia Budi, Jakarta Selatan 12950 Indonesia
④ Port of loading ⑤ Port of Discharge * COUNTRY OF ORIGIN : USA, INDIA, MALAYSIA
SINGAPORE BALIKPAPAN * SHIPMENT NO :
INDONESIA * HS CODE: 68151990
⑥ Carrier ⑦ Sailing on or about
TBN TBN
⑩ Mark and numbers ⑪ Description of Goods ⑫ Quantity ⑬ Net- ⑭ Gross- ⑮ Measure
of PKGS Weight Weight -ment

PROJECT NAME : RDMP RU-V BALIKPAPAN PROJECT

OWNER / CONSIGNEE : PT. KILANG PERTAMINA BALIKPAPAN
PORT OF DISCHARGING : BALIKPAPAN, INDONESIA
P/O NO. : 26071-100-POA-JL11-00001
ITEM DESCRIPTION : Control Valve
PACKAGE NO. : Total 2 Packages
NET WEIGHT : 9 KGS
GROSS WEIGHT : 10 KGS
DIMENSION : 0.088 CBM
COUNTRY OF ORIGIN : China
STORAGE CATEGORY MARK : B

EQUIPMENT AND MATERIALS FOR RDMP RU-V BALIKPAPAN PROJECT, INDONESIA

ITEM DESCRIPTION :
MASTER LIST NO:
1 NIU
ITEM NO.
SUB ITEM

Total 2 Packages 9KGS 10KGS 0.088CBM

- DETAILS ARE AS PER ATTACHED SHEET(S)

Signed by

Emerson Asia Pacific Private Limited

 PAGE NO. 2 OF 2
ATTACHMENT OF PACKING LIST
SHIPMENT NO. INVOICE NO.: -
Net Gross Dimension
No.of Packing Volume
Description of Goods Identy Code HS CODE Q'ty Unit Weight Weight LxWxH
PKG Type (CBM)
(KGS) (KGS) (CM)

0Y0873X0082_GASKET ~ 4.56X5.23X.03 0Y0873X0082 68151990 1 pcs

1E5629X0072_GASKET ~ 2.00X2.50X.03 1E5629X0072 68151990 1 pcs
1K4515000A2_TORQUE TUBE ASSY 1K4515000A2 90269000 1 pcs
1 OF 2 Box 4.4 5.2 50 x 50 x 26 0.065
GE93321X012_DISPLACER 3X14.17 GE93321X012 84819090 1 pcs
R249BX00012_KIT,REPAIR ~ 249B AND 259B SPARES R249BX00012 90269000 1 pcs
R2500F00012_KIT,REPAIR ~ 2500-249 HEAT INSULATOR R2500F00012 90329090 1 pcs
2 OF 2 DLC3100_DLC-3964-5818706 DLC-3964-5818706 9032812099 Box 1 pcs 4.6 5.1 31 x 30 x 25 0.023

Total 2 Packages 7.00 9.0 10.3 0.088

 Emerson Process Management
Asia Pacific Private Limited
1 Pandan Crescent
Singapore 128461
Republic of Singapore
Tel (65) 777-8211
Fax (65) 777-0947, 777-0743

CERTIFICATE OF CONFORMANCE

Issued To : RDMP BALIKPAPAN JO

End User : PT PERTAMINA PERSERO

Customer Purchase Order No. : 26071-100-POA-JL11-00001

Fisher Reference No. : 253 -43318&A

Name of Commodity : GASKET ~ 4.56X5.23X.03 0Y0873X0082 1 EA

GASKET ~ 2.00X2.50X.03 1E5629X0072 1 EA
TORQUE TUBE ASSY 1K4515000A2 1 EA
DISPLACER 3X14.17 GE93321X012 1 EA
KIT,REPAIR ~ 249B AND 259B SPARES R249BX00012 1 EA
KIT,REPAIR ~ 2500-249 HEAT INSULATOR R2500F00012 1 EA
DLC3100 DLC-3964-5818706 1 EA

Manufacturing Code & Standards : Fisher Standard

Date : 15-Jun-23

Emerson Process Management Certified that items herein were

manufactured and shipped in conformance to FISHER product specifications and in accordance
with quality control standards common to the control valve industry.

We further certify that all items shipped herein are free from defects in material and/or
Workmanship.

Authorised Signature
Emerson Process Management