DINAS KESEHATAN
UPTD PUSKESMAS RANAP UJUNGJAYA
Jl Rd. Ali Sadikin KM 05 No 02 Ujungjaya-Sumedang Kode Pos 45383
TELP (0233) 8667264 Email : puskesmasujungjaya@yahoo.co.id
SURAT TUGAS
No : 800 / / ST-BOK/ PUSK UJ /VIII/ 2022
Tanggal : 01 Agustus 2022
Lembar Ke :1
Kode No. :-
Nomor : 800/ /PUSK UJ/VIII/2022
Dikeluarkan di : Sumedang
Pada Tanggal : 01 Agustus 2022
Kuasa Pengguna Anggaran
( ............................................ ) ( ............................................ )
NIP NIP
III. Tiba di : Desa Cibuluh Berangkat dari : Desa Cibuluh
( ............................................ ) ( ............................................ )
NIP NIP
IV. Tiba di : Desa Cipelang Berangkat dari : Desa Cipelang
( ............................................ ) ( ............................................ )
NIP NIP
V. Tiba di : Puskesmas ujungjaya Telah diperiksa dengan keterangan bahwa
perjalanan tersebut atas perintahnya dan semata-mata untuk kepentigan
(Tempat Kedudukan)
jabatan dalam waktu yang
Pada Tanggal : 02, 03, 04 Agustus 2022 sesingkat-singkatnya.
PA/KPA yang menerbitkan SPD, Pegawai yang melakukan perjalanan dinas, para pejabat yang mensyahkan tanggal berangkat/tiba serta bendahara
pengeluaran bertanggung jawab berdasarkan peraturan-peraturan Keuangan Negara apabila Negara menderita rugi akibat kesalahan, kelalaian dan
kealpaan.
LAPORAN KEGIATAN
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