Name of 1ug Boat

Name of Barge
Remarks:
Place and Date : ..,..r.....r.,..;......-..
Srgred lbr and behalf of,
PT. GEOSERVICES
The Sun'eyor
(ffi
rTlw:'
_4
1"TIl"- **,i-il-" hr rrc-tt""
@IE
{"r- ir'O?ft, I 9 9 S)
&lIarine llivisicn anel trxsni*etiox"' $el"'ices $ivision
G$-F-MR}I.C2
G*rffi*tJo11)
STA-TMNNT OF EARGE DR.AFT SURVEY
Atteneling Pl;:ce
TOlAI- CARGO I-O,{DED / DISCFIARGOD =
Anesled Lr1,
INIT{AI, Fil'lAL
Date / Time
Draft Reading Port Stir Mean Port Sltr Mean
Forv'artl
Stem Correction
Corrected
A11
Stem Conection
Corrected
Mean Fwd & A11
Midship
Midship Correction
Corrected
Mean of Means
Quarter Mean
I . e/\t I, AT
l' f,l
Correspond ing Displacement
Irim bv }{eadiStem
Trim Correction
Displacement Comected lbr Trint
Observed Density
Density Correction
Displacement Correted lbr Derrsitv
Total Cosuntbale Stores and Ballast
I
Qltcf
'
tt,r
Net Displacement
T-y- r-
!*. ,
f
.F**"-- .--_T .'
v-'L
Name of Tug Boai
Name ol Barge
Remarks:
Place and Date : ...........,......,..,..
Srgrred ibr and behalfol,
PT. GEOSERVICES
( ..... ....... .)
fire Surveyor
PT" {i*oservice:r
*
Inspection Bo dy Aearedi*atior ({SO/IE L1 1
"i
1}2CI : 1998)
Marime Division and krspecrlon Service$ l)ivisiorii
GS-b'-M{rN-0?
(i:,:
*_Llx'j":i!ll:::.:"-0j_1i
1.r! 111"1.t"*
ST?ITMENT OF EAR.GB DRA.FT SLIRVEY
Attending Pi,ice
TOTAI, CARCO LOADED / DISCHARGED =
Attested by
--*r
II{ITIAL F'tNAL
Date./ Time
Draft Reading Port Stb Mean Port st l) Mean
Forward
Stem Correction
Corrected
Ali
Stem Correction
Corrected
Mean Fwd &.{ft
Mirlship
Midship Correction
Corrected
Mean of Means
Quarter
Mean
Corresponding Displacement
frim b1- Head/Stem
Trim Correction
Displacement Correctetl lbr Trim
Observed Densitr
Density Correction
Displacement Correted for Der.rs ity
Total Cosunbale Stores and Ballnst
{ZbG P1
I
taq
Net Displacement
IJ.W {YTT
t'qog t\4
,
a,
?,r'-,*' '--7--.-:
Name of Tug Boat
Name of Barge
Remarks:
Place and Date : ........................
Srgnecl for and behalfol,
PT GEOSERVICES
ft;i;;"y";
Pr.6;*";i-* - oro,1rr8)
Marine Division and fmspe:c{irira Services Divisio,m
GS.F-MRN-02
(issuc : l, Revision : 0, Date issue : 0 1 Au;iust, 20 t1)
STATME]\T OF BAR.GE Dru"FT SURVEY
,Attending Piace
TOIAI- CARG0 LOADBD / DISCHARGED
=
Attested by
IJqIT'AL
t,
iTINAL
Date I Time
{qw.
*-;t0t4{A1
Draft Reading Port stb Mean Port 1[] Mean
Forfuard
Stem Correction
Corrected
A11
Stem Corection
Corrected
Mean F-wd & Att
Midship
Midship Correction
Corrected
Mean of Means
Quarter
Mean
It t I
0,Ar\ l, CIl
Corresponding Dispiacement
lrim by FleadiStem
Trim Corection
Displa-cement Correctetl tbr'lrim
Observed Density
Density Correction
Displacement Correted tbr Density
Total Cosrurrbale Stores and Brllnst
a
{ttl
[+r
t
Net Displacenrent
{q fiA
)e
( .. ... )
No. Form
SKAB & SURAT KIRIM
ABN-FM-CPP/JTY-01
Ta ngga I Revisi Haiaman
30-l a n-14 1. 3-of2
Dengan ini memberikan Surat Keterangan Asal Barang kepada :
Berdasarkan :
1. Kode Wilayah
2. IUP Operasi Produksi
- Nama
- Alamat
Nama BG - TB
Muatan
Jumlah (MT)
Tujuan
SURAT KETERANGAN ASAL BARANG
Nomsr : 2342/SHIP-SKAB/ABN/Vl
1701,4
KTN 2009 1691 0P
54O
1
1.6e1
/
tUp-O
p/
M B-
p
B AT
/Xil I
ZAA1
KOREA SOUTHERN POWER., LTD.
KOREA SOUTHERN POWER., [TD.
MIRAE ASSETTOWER 3RCI FLOOR,
620, TEHERAN-RO, GANGT{AM-G U,
sEOUL, KOREA,135.501
BG : NAII?rCA
1 5
/'
T": AEPfNE
$q$Ilm I 5
Batu ba ra
5.?5
MT
Transhipment to MUARA BERAU MV. CHIOS SUNRISE
Dan menyatakan bahwa batubara yang diangkut ini adalah benar konsesi kami, Surat
Keterangan Asal Barang ini dipergunakan untuk keperluan angkutan Batubara sarana
Pengangkut sebagai dokumen pelengkap keberangkatan Tug Boat dan Barge :
Demikianlah Surat Keterangan Asal Barang ini dibuat untuk dipergunakan sebagaimana mestinya dan
berlaku untuk 1 ( satu
)
kali pengangkutan.
Pendin8in,l4 luni 2014
PT. ADIMITRA BARATAMA NUSANTARA
Kepala Teknik Tambang
Tembuson : - Arsip
nasvirHr rvt
I itt, :'i ;. r,.*: 1,"1.,,'.u
a j*l+;;
,ir;.,{:::rE:":
No. Form
SKAB & SURAT KIRIM ABN. FM.CPP/JTY_01
Tanggal Revisi Halaman
30-ian-14 1 1"of2
SURAT KIRIM
Berdasarkan
1. Kode Wilayah
7. IUP Operasi Produksi
Tujuan
Pengangkut
3. Angkut
- Kepada
N o m or : 2342/ SHI P-S K/ABN/V
V
2A14
KTN 2009 1691 0P
s 40
I
1.6e1
/
tup-o
p/M
B-
p
B AT
/xil /
2o0s
Tanggal 01 Desember 2009
Transhipment to MV. CHIOS SUNRISE
Bc.
NALITrGA
16
TB.
ATPI}& Mfi.ffTM
T'6
Batubara
KOREA SOTJTHERN POWER., LTD.
Pengirim
PT. Adimitra Baratama Nusantara
I
EaratamE Nusantara
+
Nomor Nama Barang Banyaknya Keterangan
1 Batubara
7
r
5o5
t'tr AB$
59
Is
Diberikan di Pendingin, kecamatan Sangasanga, Kabupaten Kutai Kartanegara, Kalimantan Timur.
( Pelabuhan Khusus PT. Adimitra Baratama Nusantara
)
Pendingin,$4 Juni 20t4
Pengangkut
Nahkoda
Master
Lembar 1 Untuk Pembeli
Lembar 2 Untuk TB/TKIKPL
Lembar 3 Untuk Kantor Pertambangan dan Energi Kutai Kartanegara
Lembar 4 Arsip
Kepala t6knikrambang
* ,o
-
;fu,ndi,milra
Mother Vessel :
Tug Boat
Barge
Quantity
Tongkang ke
59.rs
L"
Dibuat oleh,
o
im.o.,
C+1165
SurerEE
A.u
, t,o
\LArTrce
lb
+
TIME SHEET TONGKANG
cargo ,T.rqlt
fif
:n?t3
5
t
XZ
Al
I
Waktu
Aktivitas
Tanggal Mulai Sta rt
L4-6-L4
I
A
b
T
U
17tEo
t7'4r
nfa
t7,ea
t7.49
22"t
ae,
a0
2s.qo
2\'.79
l"
lx
l+
I
Porrt-irn
d f sanAarFa{l
-
Tn?+iat
dwy,
Runnfln4i
-v
p.r-l=
1..i7,2r
-
r_
'
;'
-
L',\1 ,tg
GaW
d(
hx^
L
Z ,1f
i t,
Loadfnq
ga{.
4
.'
1'e7 '
Oa+e
di
ltrup
"
Stof
lwa?^tu
/
lnal
dray
L l<ovpurc
)
Crtt+
"{f
-
* Ko7Aaan
ton2kar$-a,w-vn
-
WTabW
pryk"E
@ranaa,v1
Disetujuioleh,
trRffiW$$IONAL RHPORT CIF BARGE DRAUGI.IT SURVEY
!I-lI**ti#+i
lfEll$NWN=:r'
\\rr\Nsia..
SUCOFINDO
Barge
Tug Boat :
Flag :
Wharf :
Port .
fA
t.A.
llationality / Flag :
f-iEht tihip :
Cargo :
B/L Quantity :
lnstruction Received From :
INITIAL FINA[-
Date and hours
a Forward port
b. Forward starboard
c. lVlean Forward / Forward correction
d. ,After port
e" After starboard
f. Mean after /Aft. Correction
S.
Fore & After mean
h Midship port
i MicJship starboard
j.
Mean, Midship / Mid correction
k. Mean of means
i. Mean of means corrected for deformation
m. Displacement
n. Trim correctinn
'lst
2nd
o. Total trim correction
r
Trim (ft/m)
r
TPt/TPC (LT/MT)
r
LCF (ft/m)
r
D-MT| (C) (LT/MT)
r
LBP (ft1m)
p. Displacement corrected for trim
q List correction
r. Displacement corrected for list
s. Observed density (kg/m3)
t. Density correction
u. Displacement corr. for density
v. Deduct weight
w, Net displacement
x. lnitial
y. Final
z. Cargo Discharged / Loaded
(feet/m) (feetim)
LT/MT LT/MT
Loaded / Light
Loaded I Light
Reniarks & Sea state :
20.......
Acknowledged by:
Master / Chief Officer
F0RiMlr\-oPS/011 Rev : 00
Surveyor
Page:1ofl
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I
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e E
I
n
. :]
&.il$[{ifl&YiEffi
$}ffitrVfi$IONAL RHPCIRT OF BARGE DRAIJGI{T SURVEY
,/I\\.$':$S\
#Sf,&Y$SNiN,,,t
EWISDdHSN$S,:'
:,
\ll9, \HSrs ' -
SUCOFINDO
Barge
Nationality / Flag
Light Ship
Cargo
BIL Quantity
Tug Boat :
Flag :
Wharf :
Port :
T.A. :
lnstruction Received From :
Remarks & Sea state :
Acknowledged by :
Master / Chief Officer
FORIMIN-OPS/011
Surveyor
'
Page: 1 of 1
INITIAL FINAL
Date and hours
a Forward port
b" Forward starboard
c. Mean Forward / Forurard correction
d. Afler porl
e. After starboard
f. Mean after / Aft. Correction
S.
Fore & After mean
h Midship port
i. Midship starboard
j.
Mean, Midship / Mid correction
k. Mean of means
L Mean of means corrected for deformation
m. Displacement
n. Trim correction 1st
2nd
o. Total trim correction
E
Trim
r
TPI /TPC
N
LCF
I
D-MTI(C)
N
LBP
(ft/m)
(LT/MT)
(ft/m)
(LT/MT)
(ft/m)
Displacement corrected for trim
l-ist correction
Displacement corrected for list
Observed density (kg/m3)
Density correction
Displacement corr. for density
Deduct weight
Net displacement
lnitial
Final
Cargo Discharged / Loaded
(feeUm)
LT/MT
(feeUm)
LT/MT
Loaded / Light
Loaded / Light
Rev : 00
ru
Ei.g
I
-
rt
a
i. ;.: I
, .I::) ,r:.i
H
rc
iERffiVI$IONAL
REPORT
OF BARGE
DRAUGHT
SURVEY
/dt\ ddN\
il6$gLY.NISR
EGEE{'NS$S
\ty,
sNWs
SUCOFINDO
{3ai"ge
Nationali\i
I Flag
t-ight
ShiP
Cargo
B/l- QuaniitY
Tug tsuat .
Flag :
Wharf .
Port .
"l-.A
:
a Foru'rard Port
b. Forward starboard
Mean Forward / Forward correction
After
port
After starboard
Mean after / Aft. Correction
Fore & After mean
MidshiP Port
MidshiP starboard
Mean, MidshiP I Mid correction
Mean of means
Mean of means corrected
for deformation
Displacement
Trim correction 1tt
2nd
Total trim correction
s
Trim
I
TPI /TPC
E
LCF
(ft/m)
(Lr/MT)
(ft/m)
.
D-MT|
(C)
(LT/MT)
r
LBP
(ft/m)
p. Displacement
corrected
for trim
q. List correction
r. Displacement
corrected
for list
s. Observed
densitY
(kg/m3)
t. DensitY correction
u. DisPlacement
corr. for densitY
v. Deduct weight
w, Net disPlacement
x. lnitial
y. Final
z. Cargo Discharged
i Loaded
Loaded / Light
Loaded / Light
lnstruction
Received
From
Acknowledged
bY:
Master / Chief Officer
F0FtiMlN-oPS/011
Rev :00
Surveyor
Page:1of1
I
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I
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