GMP-154-013, Attachment #1 “Field Change Notice" Page: 1 of 1 < GS Engineering & Construction Corp. Id Change Notice Client 2 Pertamina | Date 08 Sep. 2014 Project #_Cilacap RFCC Project FCNNo. : 101830-FCN-EL-009 Contract No. : 15/C00000/2011-S2 Discipline : Electrical 1. Subject New Con’c Floor Opening for Cable Tray Route from Cable Trench 2. Reason for Changes Change by Licensor Change Request by Client Design Error (Originator : Process] Mech.() PipingL] Elec.M) instr.) CASO) FFU Ete.00 / Petal Reason : Internal ErrorC Clash Error] Revised Inform.C] Coordination Error VP Miss Reading Det.) © Construction Error © Hold Release / V.P Follow-up (Late Information by Purchase) © Wrong Packing or Fabrication by Vendor C1 Others (Design development.) 3, Construction Status 4. Instruction for Construction Works Before Fabrication | Installation Hold Construction Works, After Fabrication / Installation Continue Construction Works 8. Applicable Drawings (Owg. No, / Rev. No, / Description) RFCC-G-EL-VP-P0004-DRO06-A3 6. Description of Changes (To Describe in Detail) New Con'c Floor Opening for Cable Tray Route 7. Engineering Assessment of Changes Issue Change Work to Owner 1 Issue Change Work to Vendor ‘Adopt Changes Issue Change Work to Subcont 8. Attachment (To Include Bill of Quantity) RFCC-G-150-EL-PL-201-AU~1 sheet, UG Composite dug: 1 sheet 9. Distribute to Project Control Team Cl Eng'g Coord,» WH_Comstuction (Elee,) Procurement G Process Mechanical Ci Piping (FE Team) Instrument Electrical (FETeam) MICAS (Const./FE Team) —) FIF 5 sue Monon Ty AAP RE ~ ¢ | By UWNEK(N.A) Required » > Sign Zp Sign Sign igt Fal yi ig ig Name YHtee J.Schoi Klee Name Name Date 08 Sep. 2014 08 Sep, 2014 08 Sep. 2014 Dato Date Prepared Auproved Approved Confirmed "Note : This FCN shall be registered in FON Tool system S&S Engineering & Construction GMP-154-013-01(1)Gin | _HONSUL “OF ‘ea9d O06E "onbe * mooes gen HONS “OFT eh cy ‘060/—"Ta_L0e |ao601 = noo gen_[_HONSIL is iS af “OMG 33S JNM HOLY O601="3_108 ‘qo6or x wO00! celes-d zen | HONRL “O31 7G 108 MOOah (NM) BH ocos-a-zst of ‘its — Ee OS1—-9-yUda “ON OV-L0Z—Id—13—-ZagosS | a O78 | ‘ON “OMG 34S = joa f ef: —oso7—a 10g * MOOEZ A : GOvL x _MOOBt d iLa2ys V - off -1ez-3d-72- 284 -B - dd a “da WoOr ay “NV BedLeeks p Boe yet? BL AVM SS390V