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 FORMULIR 5 LAMPIRAN PERA TURAN MENTERI KESEHAT AN NOMOR : 143/MENKES/P ER/VII/77 TANGGAL : 1 JUL I 197 7 HASIL PE NGUJIAN KESEHATAN NO / DPT / 2012 / /812 D!"#$ P#%&'() T#$*#%+)$) /T#,- P#%&'() /T#,- K.'*'* P#%&'() K#*#.,",% P#&,,) N#&#$) S)) +) T#-),.,% , %& +) "# ", !,% #$+ ,* ,$ !,% S'$," K# ' "' *, % K# , , D)%, * K# *# .,",% P$ R),' N - $:8 00 /S#! $ TU/SK/DPT/2 01 1/19 T ,%&&, 03 J,%',$) 2011 ,%& ,%&&",,%&&",%, +,,- ., )%) "#,. -#%(,,%!, % "'&,*%, +#%&,% -#%&)%&," *'-,. 6 (,%() ,%& "#,. +)',!,% -#$#!, ,!"' -#%#$)-, (,,",%%, -#%#$,%&!,% ,., : N , - , : R#*!) M,$) N,-, K#) : R#*!) N I P : 1992030 201012 1 001 K,$#& : T #-,"/T& ,.)$ : T ,%('%& U,% 3001992 G%&,% $',%& : 6 II/, P#!#$(,,% : ;,% P#&,,) N#&#$) S)) A ,-," : J P# , '. ,% N 1 K' , , E% ! "# , . +) # $) !* , +# %& ,% "# ) ") ,",* #$-)% ", ,% K#,, K,%"$ A+-)%)*"$,"$ P#,'.,% K',, E%! +#%&,% *'$," N:KP004/1/1/ ADKE2011 T,%&&, 28 N<#-#$ 2011 D,% #$#%+,," ,., ,%& +)#$)!*, : , M#-#%'.) * ,$," ' %"'! * #-', ( #%)* #!#$( ,,% ,+, '- '-%, M#-# %'.) *,$, " '% "'! (#%)* #!# $(,,% "#$"#%"' D,, " +)"#$ )-, +# %&,% #$*, $," '% "'! 6 , ,", ' 6 "#$*# '" +) ,",* + U%"'! *#-#%",$, #'- -#-#%'.) *,$," !#*#.,", % +,% -#-#$'!,% #%&," ,% / # $,,",% + ,% '(),% !#*#.,",% #$' +)',%& *#"#,. *##*,) #%&,",% / #$,,",% ,",' +)",! '%"'! *#-#%",$, # T)+,! -#-#%'.) *,$," '%"'! -#%(,,%!,% "'&,* *# ,&,) P #&,,) N#&#$) S)) ," ,' +)" ,! H,*) #%&'(),% !#*#.,",% )%) +)#$)!,% ,",* %,-, DPT / TPK P#$,"'$,% P#%&'(),% K#*#.,",% N-$ 2 T,.'% 1977 ",%&&, 30 A$) 1977  T#-),.,% 29 N#-#$ 2011 S,)%,% H,*) K#'"'*,% P#%&'() K#*#.,",% +)!)$)- !#,+, : D!"#$ P#%&'() T #$*#%+)$) 1D)%!#* P$)%*) R), ' +) P #!,%,$' 2=,%& >#$*,%&!'",% 3A$*)  dr.H.Udin Syafriudin  NIP 1970415 200903 1 004  FORMULIR 5 LAMPIRAN PERA TURAN MENTERI KESEHAT AN NOMOR : 143/MENKES/P ER/VII/77 TANGGAL : 1 JUL I 197 7

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7/24/2019 DINAS PELABUHAN

http://slidepdf.com/reader/full/dinas-pelabuhan 1/11

  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2012 / /812

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 dr.H.Udin Syafriudin

  NIP1970415 200903 1 004

  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATAN

7/24/2019 DINAS PELABUHAN

http://slidepdf.com/reader/full/dinas-pelabuhan 2/11

NO / DPT / 2011 / /812

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 dr.H.Udin Syafriudin

  NIP1970415 200903 1 004

7/24/2019 DINAS PELABUHAN

http://slidepdf.com/reader/full/dinas-pelabuhan 3/11

  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2011 / /812

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 dr.H.Udin Syafriudin

  NIP1970415 200903 1 004

 

FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2011 / /812

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11  

dr.H.Udin Syafriudin12 NIP1970415 200903 1 004

  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2011 / /812

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14  dr.H.Udin Syafriudin

15 NIP1970415 200903 1 004

7/24/2019 DINAS PELABUHAN

http://slidepdf.com/reader/full/dinas-pelabuhan 6/11

  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2011 / /812

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17  dr.H.Udin Syafriudin

18 NIP1970415 200903 1 004

  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATAN

NO / DPT / 2011 / /812

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20   dr.H.Udin Syafriudin

21 NIP1970415 200903 1 004

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  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2011 / /812

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23  dr.H.Udin Syafriudin

24 NIP1970415 200903 1 004

7/24/2019 DINAS PELABUHAN

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  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2011 / /812

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2  dr.H.Udin Syafriudin

27 NIP1970415 200903 1 004

7/24/2019 DINAS PELABUHAN

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7/24/2019 DINAS PELABUHAN

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  FORMULIR 5 LAMPIRAN PERATURAN MENTERI KESEHATANNOMOR : 143/MENKES/PER/VII/77TANGGAL : 1 JULI 1977

HASIL PENGUJIAN KESEHATANNO / DPT / 2012 / /812

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29  dr.H.Udin Syafriudin

30 NIP1970415 200903 1 004