Form Barang Cilacap.docx

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KEMENTERIAN PERINDUSTRIAN

BADAN PENELITIAN DAN PENGEMBANGAN INDUSTRI

BALAI BESAR TEKNOLOGI PENCEGAHAN PENCEMARAN INDUSTRI Jl.Ki Mangunsarkoro No. 6 Telp.(024)8316315,8314312,8310216 Fax. (024) 8414811

PERMOHONAN IJIN MEMASUKAN BARANG Nama Perusahaan

: Balai Besar Teknologi Pencegahan Pencemaran Industri Semarang (BBTPPI) : Jl. Ki Mangunsarkoro No. 6 Semarang : Pengambilan Sampel air buangan, air permukaan, air tanah : Area Kilang dan sekitarnya : Memasukkan Peralatan Kerja :

Alamat Perusahaan Obyek Pekerjaan Lokasi pekerjaan Keperluan PO No. Daftar Barang : No

Nama Barang

Jumlah

Satuan

1

pH meter + Thermometer

2

Sechi Disk

buah

3

Botol Sample

buah

4

Ember

buah

5

Gayung

buah

6

Ice Box

buah

7

Tali

Keterangan

set

rol

Semarang, Menyetujui HSE

Mengetahui Pos Sekuriti P-3 / A. 70

.........................................

....................................

F.5.7/0/1/3

Industrialisasi Meuju Kehidupan Yang Lebih Baik

BBTPPI

....................................

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