PT.

PLN (Persero)
PROYEK PEMBANGKIT DAN JARINGAN TANGGAL PEMERIKSAAN :
JAWA TIMUR, BALI dan NUSA TENGGARA NOMOR TOWER :
TYPE TOWER : T/S( )

A GROUND WIRE FITTING Baik / Tidak Catatan

1 Suspension set /
2 Armour Rod set /
3 Dumper set /
4 Tension Clamp pcs /
5 Jumper set /
6 Joint Sleeve pcs /

B INSULATOR FITTING Baik / Tidak Catatan

1 Double Suspension set /

2 Single Suspension set /
3 Double Tension set /
4 Single Tension set /
5 Jumper Support Insulator set /
6 Jumlah Insulator pcs /
7 Arching Insulator pcs /
8 Suspension Clamp pcs /
9 Tension Clamp set /
10 Jumper set /

C CONDUCTOR FITTING Baik / Tidak Catatan

1 Armour Rod set /

2 Joint Sleeve pcs /
3 Repair Sleeve pcs /
4 Spacer Line pcs /
5 Spacer Jumper pcs /
6 Dumper set /
7 Conductor mtr /

Keterangan :

FINAL CHECK SUTT 150 kV LAMONGAN - PACIRAN

Lamongan,

Mengetahui, Kontraktor
PT. PLN (Persero) PT. PLN (Persero) PT. MODERN SURYA JAYA
PROKITRING JTBN PROKITRING JTBN

DJOKO SUSILO SOEPENO WARSITO

 PT. PLN (Persero) PROKITRING JTBN CATATAN SITE SURVEY
JL. Ketintang Baru I No. 1 – 3 SURABAYA
FINAL CHECK SUTT 150kV RUNGKUT - SURABAYA SELATAN

No. Tower :
Type Tower :
Tanggal :
No. Tower
A. Ground Wire Fitting : Baik / Tidak PT. PLN (Persero)
1 Suspension : Set / PROKITRING JTBN
2 Armour Rod : Set /
3 Dumper : Set /
4 Tension Clamp : Pcs /
5 Jumper : Set /
6 Joint Sleeve : Pcs /
B. Insulator Fitting : SOEPENO
1 Double Suspension : Set /
2 Single Suspension Set
3 Double Tension : Set / PT. PLN (Persero)
4 Single Tension Set
5 Jumper Support Insulator : Set / UPT - SURABAYA
6 Jumlah Insulator : Pcs /
7 Arching Horn : Pcs /
8 Suspension Clamp : Pcs /
9 Tension Clamp : Set /
10 Jumper : Set / TAWI W D.
C. Conductor Fitting :
1 Armour Rod : Set /
2 Joint Sleeve : Pcs /
3 Repair Sleeve : Pcs /
4 Spacer Line : Pcs /
5 Spacer Jumper : Pcs /
6 Dumper : Set / LISMAN
7 Conductor : Mtr /
CATATAN :
Pengawas Lapangan

SOEPENO
 PT. PLN (Persero) PROKITRING JTBN
JL. Ketintang Baru I No. 1 – 3 SURABAYA
FINAL CHECK SUTT 150kV RUNGKUT - SURABAYA SELATAN

No. Tower : No. Tower :

Type Tower : Type Tower :
Tanggal : Tanggal :
Line I Line II
A. Ground Wire Fitting : Baik / Tidak A. Ground Wire Fitting : Baik / Tidak
1 Suspension : Set / 1 Suspension : Set /
2 Armour Rod : Set / 2 Armour Rod : Set /
3 Dumper : Set / 3 Dumper : Set /
4 Tension Clamp : Pcs / 4 Tension Clamp : Pcs /
5 Jumper : Set / 5 Jumper : Set /
6 Joint Sleeve : Pcs / 6 Joint Sleeve : Pcs /
B. Insulator Fitting : B. Insulator Fitting :
1 Double Suspension : Set / 1 Double Suspension : Set /
2 Single Suspension Set / 2 Single Suspension Set /
3 Double Tension : Set / 3 Double Tension : Set /
4 Single Tension Set / 4 Single Tension Set /
5 Jumper Support Insulator : Set / 5 Jumper Support Insulator : Set /
6 Jumlah Insulator : Pcs / 6 Jumlah Insulator : Pcs /
7 Arching Horn : Pcs / 7 Arching Horn : Pcs /
8 Suspension Clamp : Pcs / 8 Suspension Clamp : Pcs /
9 Tension Clamp : Set / 9 Tension Clamp : Set /
10 Jumper : Set / 10 Jumper : Set /
C. Conductor Fitting : C. Conductor Fitting :
1 Armour Rod : Set / 1 Armour Rod : Set /
2 Joint Sleeve : Pcs / 2 Joint Sleeve : Pcs /
3 Repair Sleeve : Pcs / 3 Repair Sleeve : Pcs /
4 Spacer Line : Pcs / 4 Spacer Line : Pcs /
5 Spacer Jumper : Pcs / 5 Spacer Jumper : Pcs /
6 Dumper : Set / 6 Dumper : Set /
7 Conductor : Mtr / 7 Conductor : Mtr /
Setelah di final check masih tanggung jawab kontraktor

Surabaya,
Mengetahui ;
PT. PLN (Persero) PT. PLN (Persero) PT. PLN (Persero)
PROKITRING JTBN PROKITRING JTBN UPT - SURABAYA

DJOKO SUSILO, BE SOEPENO TAWI WD. LISMAN

KBSL
 Malang,

Pengawas Lapangan PT. PLN (Persero)

UPT - MALANG

SOEPENO AGUSTINUS S. SUIMAM R.

 PT. PLN (Persero)
PROYEK PEMBANGKIT DAN JARINGAN TANGGAL PEMERIKSAAN :
JAWA TIMUR, BALI dan NUSA TENGGARA NOMOR TOWER :
TYPE TOWER : T/S( )

A GROUND WIRE FITTING Baik / Tidak Catatan

1 Suspension set /
2 Armour Rod set /
3 Dumper set /
4 Tension Clamp pcs /
5 Jumper set /
6 Joint Sleeve pcs /

B INSULATOR FITTING Baik / Tidak Catatan

1 Double Suspension set /

2 Single Suspension set /
3 Double Tension set /
4 Single Tension set /
5 Jumper Support Insulator set /
6 Jumlah Insulator pcs /
7 Arching Insulator pcs /
8 Suspension Clamp pcs /
9 Tension Clamp set /
10 Jumper set /

C CONDUCTOR FITTING Baik / Tidak Catatan

1 Armour Rod set /

2 Joint Sleeve pcs /
3 Repair Sleeve pcs /
4 Spacer Line pcs /
5 Spacer Jumper pcs /
6 Dumper set /
7 Conductor mtr /

Keterangan :
 PT. PLN (Persero)
PROYEK PEMBANGKIT DAN JARINGAN TANGGAL PEMERIKSAAN :
JAWA TIMUR, BALI dan NUSA TENGGARA NOMOR TOWER :
TYPE TOWER : T/S( )

A GROUND WIRE FITTING Baik / Tidak Catatan

1 Suspension set /
2 Armour Rod set /
3 Dumper set /
4 Tension Clamp pcs /
5 Jumper set /
6 Joint Sleeve pcs /

B INSULATOR FITTING Baik / Tidak Catatan

1 Double Suspension set /

2 Single Suspension set /
3 Double Tension set /
4 Single Tension set /
5 Jumper Support Insulator set /
6 Jumlah Insulator pcs /
7 Arching Insulator pcs /
8 Suspension Clamp pcs /
9 Tension Clamp set /
10 Jumper set /

C CONDUCTOR FITTING Baik / Tidak Catatan

1 Armour Rod set /

2 Joint Sleeve pcs /
3 Repair Sleeve pcs /
4 Spacer Line pcs /
5 Spacer Jumper pcs /
6 Dumper set /
7 Conductor mtr /

Keterangan :

Surabaya,
Mengetahui ;
PT. PLN (Persero) PT. PLN (Persero) PT. PLN (Persero)
PROKITRING JTBN PROKITRING JTBN UPT - SURABAYA

DJOKO SUSILO, BE SOEPENO TAWI WD. LISMAN

KBSL
 PT. PLN (Persero)
PENYALURAN DAN PUSAT PENGATUR BEBAN JAWA BALI TANGGAL PEMERIKSAAN :
SEKTOR TRANSMISI TEGANGAN EKSTRA TINGGI TYPE TOWER : T/S ( )

No Span Tower KET. CATATAN

C NC
C NC
C NC
C NC
C NC
C NC

KET.
C NC
C NC
C NC
C NC
C NC
C NC
C NC
C NC
C NC
C NC
C NC
C NC

KET.
C NC
C NC
C NC
C NC
C NC
C NC
C NC

KET.
C NC
C NC
C NC
C NC
C NC
C NC
C NC

Surabaya,

PT. PLN (Persero) PROKITRING JTBN PT. PLN (Persero) P3B-RJTB PT. PLN (Persero) UPT SURABAYA

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