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Kode Kemasan :

LAPORAN HASIL PENGUJIAN

Nama Laboratorium : .....................................................................................

Alamat : .....................................................................................

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Personil Penghubung : .....................................................................................

Hp : .....................................................................................

Hasil Pengujian
Parameter U* Satuan Metode
Simplo Duplo
Sulfat (SO4)

Clorida (Cl2)

Nitrat (NO3)

U* adalah ketidakpastian diperluas pada tingkat kepercayaan 95% dengan factor cakupan (k)=2

Catatan :

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, ...........................................

Mengetahui :
Kepala .. Penanggung jawab Laboratorium

NIP NIP

FR.PUP.KT.001/Rev.0/30.03.17
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