form is puskes

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    FORMUL

    PADA R

    BULAN :

     TAHUN :

    RUANG :

    PETUGAS :

    NO Kegiatan1 2 3 4 5 6 7 8 9 10

    PENGUKURAN LINGKUNGAN FIIK 

    a. Pencahayaan

    b. Suhu

    c. Kee!baban

    PE!ANTAUAN KUALITA AIR

    a. "H

    b. S#$a %&'

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    Men(e)ahu#*

    Ke"aa Pu$+e$!a$ Wana$a'#

    "#$ E#ni %e#"iani

    NIP. ,-/,0,1 022/23 0 224

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  • 8/15/2019 Form is Puskes

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    Be+a$#*

    Pe)u(a$ Ke

    E$ &'(a

    NIP. ,-51

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    30 31

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      (+un(an

    * A!KL$

    , , 22-

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    FOR!ULIR PE!ERIKAAN

    BULAN :

     TAHUN :

    RUANG :

    PETUGAS :

    NO Kegiatan1 2 3 4 5 6 7 8 9 10 11

    ,.

    0.

    1.  6en7ea $u7ah 7#be'$#h+an

    3.

    4.

    /. Me8a $u7ah 7#a"

    . Me!be'$#h+an 9a$)ae

    Lan)a# $u7ah be'$#h;)#7a+#c#n

     Te!"a) $a!"ah $u7ah7#+&$&n(+an

    Pe'aa)an 7#'a"#+an+e)e!"a) $e!ua

    Pene'an(an !a$#hbe'un($#

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    5. Me'a"#+an )e!"a) )#7u'"a$#en

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     ,AN +ANGUNAN PUKE!A -ANAARI

    Tanggal15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

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