INSPECTION AND TEST PLAN

ON-SHORE PIPELINE CERTIFICATION

Project : TRUNKLINE 6" FROM MT-L-8385 M.8 STATION TO MT-R-6205 M.6 STATION
Owner : PT. PERTAMINA HULU SANGA SANGA
User : PT.PUTRA TUNGGAL MANDIRITMA
Location : PHSS KALTIM
3rd Party Insp. : Migas Letter assignment R : Review SW : Spot Witness
No. : - S : Surveillance / Inspection V : Verify
Project Ref. : Tgl. : - W : Witness Inspection H : Hold point
Project Duration : P : Perform & Provide N/A : Not Applicable

Surveillance Inspection
Reference Acceptance 3rd Party
No Activity
Document Documents required Criteria PTM PHSS Insp. Comp. MIGAS

1 Document Review
- QA / QC Procedure SNI-13-3474 QA Manual, QC Procedure SNI-13-3474 P R R
- Construction procedure Owner Spec.& SNI-13-3474 Construction Procedure Owner Spec.& SNI-13-3474 P R R
- Design basis
a. Pipeline routing, incl. ROW Owner Spec.& 300K Design document Owner Spec.& 300K N/A P R
b. Physical and chemical characteristics of fluid Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R
c. Material selection incl. Internal corrosion
assessment Owner Spec.& API Spec 5L Design document Owner Spec.& API Spec 5L N/A P R
d. Temperature / pressure profile Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R
e. Pressure containment (wall thickness calc.) Owner Spec.& SNI-13-3474 Calculation sheet Owner Spec.& SNI-13-3474 N/A P R
f. Pipeline expansion (if applicable) Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R
g. Free span assessment (if applicable) Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R
h. Lateral snaking assessment (if applicable) Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R
I. Crossing design (if applicable) Owner Spec.& API 1102 Design document Owner Spec.& API 1102 N/A P R
j. Tie-in design (if applicable) Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R
k. Trenching assessment (if applicable) Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R
l. Pig launcher / receiver design (if applicable) Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 P R R
m. Flange calculations (if applicable) Owner Spec.& ASME B16.5 Design document Owner Spec.& ASME B16.5 N/A P R
n. T-joints, valves, etc. (if applicable) Owner Spec.& SNI-13-3474 Design document Owner Spec.& SNI-13-3474 N/A P R

- Pipeline drawings Drawings V P V

- WPS / PQR and Welder Certificate ASME IX / API 1104 WPS / PQR and Welder Certificate ASME IX / API 1104 P R R
- NDT procedure and NDT personnel certificate ASME V / API 1104 NDT procedure and personnel certificate ASME V / API 1104 P R R
- Repair procedure Owner Spec.& API 1104 Repair procedure Owner Spec.& API 1104 P R R
- Hydrostatic test procedure Owner Spec.& SNI-13-3474 Hydrostatic test procedure Owner Spec.& SNI-13-3474 P R R
- Cleaning, pigging, and drying procedures Owner Spec.& SNI-13-3474 Cleaning procedure Owner Spec.& SNI-13-3474 P R R
- Safety devices and Instrumentation system Owner Spec.& SNI-13-3474 Data sheet, manufacturer certificate Owner Spec.& SNI-13-3474 P R R
- Environmental protection and control system Owner Spec.& 84K AMDAL / UKL-UPL report Owner Spec.& 84K N/A P R
- Corrosion control system
a. Cathodic protection design report Owner Spec.& NACE Design report Owner Spec.& NACE N/A P R
b. Anode manufacturing and installation spec. Owner Spec.& NACE Design report Owner Spec.& NACE N/A P R
c. Coating manufacturing specifications Owner Spec.& NACE Design specification Owner Spec.& NACE N/A P R
d. Field joint coating specification Owner Spec.& NACE Design specification Owner Spec.& NACE N/A P R
e. Corrosion monitoring system specification Owner Spec.& NACE Design specification Owner Spec.& NACE N/A P R
f. Material take off / data sheets Owner Spec.& API Spec 5L Data sheets Owner Spec.& API Spec 5L N/A P R

- Operation and maintenance procedure Owner Spec.& SNI-13-3474 Operation & maintenance procedure Owner Spec.& SNI-13-3474 N/A P R
 INSPECTION AND TEST PLAN
ON-SHORE PIPELINE CERTIFICATION
Project : TRUNKLINE 6" FROM MT-L-8385 M.8 STATION TO MT-R-6205 M.6 STATION
Owner : PT. PERTAMINA HULU SANGA SANGA
User : PT.PUTRA TUNGGAL MANDIRITMA
Location : PHSS KALTIM
3rd Party Insp. : Migas Letter assignment R : Review SW : Spot Witness
No. : - S : Surveillance / Inspection V : Verify
Project Ref. : Tgl. : - W : Witness Inspection H : Hold point
Project Duration : P : Perform & Provide N/A : Not Applicable

Surveillance Inspection
Reference Acceptance 3rd Party
No Activity
Document Documents required Criteria PTM PHSS Insp. Comp. MIGAS

2 Site Inspection & Verification

- On-shore Installation Preparation
a. Pre-installation survey Owner Spec.& SNI-13-3474 Inspection report, check list Owner Spec.& SNI-13-3474 P S N/A
b. Extent of preparation for crossings Owner Spec.& API 1102 Inspection report, check list Owner Spec.& API 1102 P S N/A

- Pipeline Installation
a. Pipeline material inspection & tracebility Owner Spec.& API Spec 5L Material / Mill certificate Owner Spec.& API Spec 5L P W R
b. Pipeline route and ROW survey Owner Spec.& 300K Survey report Owner Spec.& 300K P R&S R&S
c. Repairs of damage to external & internal coat Owner Spec.& NACE Repair procedure, inspection report Owner Spec.& NACE P R & SW R&S
d. Welding inspection (incl. Electrode & fit-up) ASME IX / API 1104 Inspection report, check list ASME IX / API 1104 P R & SW R & SW
e. Non Destructive Testing process ASME V / API 1104 NDT procedure, NDT record ASME V / API 1104 SW R & SW R & SW
f. Excavation, welding and NDT of repairs Owner Spec.& SNI-13-3474 Procedure, Inspection report Owner Spec.& SNI-13-3474 H R & SW R & SW
g . Field joints coating / insulation (if any) Owner Spec.& NACE Coating procedure, calibration cert., report Owner Spec.& NACE P R & SW R & SW
h. Pipe lowering activities Owner Spec.& SNI-13-3474 Check list Owner Spec.& SNI-13-3474 P R&S R & SW
i. Tie-in (line-up and fit-up) Owner Spec.& SNI-13-3474 Tie-in procedure / check list Owner Spec.& SNI-13-3474 P R&S R&W
j. Trenching Owner Spec. Trenching report Owner Spec. P R&S R & SW
k. Safety devices and instrument inspection Owner Spec. Inspection report, check list Owner Spec. P R &W R&W

3 Testing and Commissioning

- Pigging and cleaning / Check gauge plate Owner Spec.& SNI-13-3474 Pigging inspection report , check list Owner Spec.& SNI-13-3474 P R&W W
- System pressure testing
a. Water sampling Owner Spec.& SNI-13-3474 Sampling report Owner Spec.& SNI-13-3474 P R V
b. Inhibitors (if applicable) Government Regulation & Catalog product Government Regulation & P R V
Owner Spec.& Appl.code Owner Spec.& Appl.code
c. Water filling Owner Spec.& 84K Check list Owner Spec.& 84K P R&S SW
d. Instrumentation and equipment calibration Owner Spec.& 84K Calibration certificate Owner Spec.& 84K P R&S V&H
e. Pressure Test 84K , Owner Spec & 84K , Owner Spec &
SNI-13-3474 Test procedure and report SNI-13-3474 P R&H H
h. Dewatering and Cleaning 84 K & Owner Spec Test procedure and report 84 K & Owner Spec P R&S R & SW
SNI-13-3474 SNI-13-3474
4 Final Report
- Installation data package / dossier Owner Spec.& SNI-13-3474 QC Inspection report, document dossier Owner Spec.& SNI-13-3474 P R R
- Certificate / Result of inspection 84K QC Inspection report, document dossier 84K N/A N/A P

Note: This ITP has been discussed and approved by all parties concerned during Pre-inspection meeting

Prepared by Review & Approved by , Review & Veryfied by, Ditjen MIGAS
PT.Putra Tunggal Mandiritama PT.Pertamina Hulu Sanga Sanga PJIT

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