: ...................................
: ...................................
NAMA ALAT / BAHAN
TANGGAL PENGEMBALIAN
TANGGAL
: ...................................
JAM PRAKTEK : ...........S/D..................
JUMLAH
KETERANGAN
: .................................................
Mengetahui,
Nusa Bakti,
Guru / Instruktur
( ................................................ )
2014
( ............................................ )
: ...................................
: ...................................
NAMA ALAT / BAHAN
TANGGAL PENGEMBALIAN
TANGGAL
: ...................................
JAM PRAKTEK : ...........S/D..................
JUMLAH
KETERANGAN
: .................................................
Mengetahui,
Guru / Instruktur
Nusa Bakti,
2014
Ketua Kelompok / grup
( ................................................ )
( .................................. )