FORM PENGAJUAN

TEST & COMMISSIONING

(LOGO PROYEK)

POMPA
Project
Proyek

Pump / Code

Package
Paket

Date of Test
Tanggal Uji

Location
Lokasi

Drawing Reff.
Referensi Gbr

Pompa / Kode

PUMP

MOTOR

Manufacturer

Type

Serial No.

Size

Model No.

Stage

Manufacturer

Type

Serial No.

Output (KW)

Frame No.

FL (AMPS)

DESIGN

P
E
R
F
O
R
M
A
N
C
E

P
U
M
P

M
O
T
O
R

TEST

FLOW RATE

L/S

L/S

PRESSURE SUCTION

kg/cm2

kg/cm2

PRESSURE DISCHARGE

kg/cm2

kg/cm2

PRESSURE NO. FLOW

kg/cm2

kg/cm2

SPEED

RPM

RPM

VOLTAGE

VOLTS

VOLTS

CURRENT

FLC (AMPS)

FLC (AMPS)

SPEED

RPM

RPM

POWER

KW

KW

TEST INSTRUMENT USED :

Diperiksa oleh,
Kontraktor Utama
PT. .

Diperiksa oleh,
Kontraktor Spesialis / NSC / DC
PT.

Diajukan oleh,
Supplier
PT. ...

(.)

(.)

(.)

Diketahui Oleh,
PT. ..
Property Management
Project Management

( .)

333218703.xls

(..)

QMS/DCC/FML-HOV/14 (R.00) - 310805

COMMENT