Doc.

No :
Date :

APPLICATION FOR INSPECTION

Attn :
:

Gentlement,
We would like to have your presence for inspection according to the following schedules.

Date and time Place / Area Inspection Item Remarks

Result Accepted Rejected

Reinspection Required Yes No

Comments :

Prepared by, Inspected by, Witnessed / Approved, by,

SUBCONTRACTOR CONTRACTOR CLIENT / OWNER CLIENT / OWNER
PT. PERTAMINA
Print Name
Signature
Date