PT.

Tapin Coal Terminal

Site Rantau - Kalimantan Selatan

MR No:

Departmen: HSE-Clinic
Date Request : 15 JUNE 2013

Material Request Form

NO Description Merk Type Size Number Unit Remarks Date Req'd

1 Tabung Oxygen + Cart (dudukan) 1 Pcs Gambar terlampir

July 2013
2 qmbu Bag 1 5et Gambar terlampir Julv 2013
3 Kanula Nasal 2 Pcs Gambar terlampir lulV 2013
4 Regu lator 1 Set Gambar terlampir .lulv 2013

5 fandu lstretcher I Pcs Gambar terlampir Julv 2013

6 limbangan Dewasa 1 Pcs Gambar terlampir Julv 2013

7 Bed Pasien (exominotion Toble I 7 Unit Gambar terlampir Julv 2013

8 Hecting Set 1 Set Gambar terlampir Julv 2013

9 Tiang lnfus 1. Pcs Gambar terlampir July 2013

1-0 Tas P3K 1 Pcs Gambar terlampir Julv 2013

11 nfus Sel 2 Pcs Gambar terlampir Julv 2013

t2 iurflo Uk 20 / dan Uk 22 2/2 Pcs Gambar terlampir Julv 2013

13 (om Kecil 2 Pcs Gambar terlampir Julv 2013

14 :ut Gut Plain Uk 2/0, 3/0 dan cut Gut chromic 2/o rl!7 Pcs Gambar terlampir July 2013
15 (ursi Tunggu 1 Set Gambar terlampir Julv 2013

15 arum Hecting (Jahit) L Set Gambar terlampir Julv 2013

L7 lourniquet t Pcs Gambar terlampir Julv 2013

18 nstrumen Table 1 Pcs Gambar terlampir Julv 2013

19 )ispenser ( Dingin & Panas ) I Unt Julv 2013

20 Refrigerator (Kulkas) Kecil (lpintu) 1 Unt luly 2013
27 Korentang t Set
Gambar terlampir Julv 2073

22 ;arung Teng=en steril Uk 7,5 2 Pes

Gambar terlamoir July 2013

Margasari, 21 May 2013

Dibuat oleh,

Diterima Oleh, GeReral Manager Operation

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