MONTHLY REPORT

ENVIRONMENT PERFORMANCE

BULAN :

LOGO PERUSAHAAN

PT. PRIMA JAYA PERSADA NUSANTARA

Adong

Tanggal

i
 Laporan Environment
Environmental Performance

KONTRAKTOR : PT. PRMA JAYA PERSADA NUSANTARA

BULAN : SEPTEMBER 2019

1. Material and Resources

a. Refrigerant Consumption
Month of Year 2019
Cummulative Year
NO Type of Refrigerant Code Unit
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec to Month

1 Chlorodifluoromethane R22 Kg 0
2 Tetrafluoroethane R134a Kg 13 13
3 Trichlorodifluoromethane R11 Kg 0
4 Dichlorodifluoromethane R12 Kg 0

b. Lubricant Consumption
Month of Year 2019
Cummulative Year
NO Type of Lubricant Unit
to Month
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Lubricant Oil Liter 0

2 Lubricant Grease Kg 0

Prepared By

…………………….
Remarks

Remarks

Page 8
 Environmental Performance
KONTRAKTOR : PT. PRIMA JAYA PERSADA NUSANTARA
BULAN : SEPTEMBER 2019
2. Waste Produced
a. Hazardouse Waste Produced
Month of Year 2019
NO Type Hazardouse Action by Mine Site Unit
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov
1 Used oil (oil bekas ) Disposed via waste collector liter
2 Remain grease (sisa grease) Disposed via waste collector kg
3 Oli filter Disposed via waste collector kg
4 Used Battery (Accumulator) Disposed via waste collector kg
5 Stationary (Cartridqe, dry battery) Disposed via waste collector kg
6 Clinical Waste Disposed via waste collector kg
7 Contaminated matters Disposed via waste collector kg
8 Laboratory Disposed via waste collector kg
9 Others (Pesticide waste, etc) Disposed via waste collector kg

b. Non - Hazardouse Waste Produced

Month of Year 2019
NO Type Non-Hazardose Waste Action by Mine Site Unit
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

1 Domestic Disposed on-site Kg 100

2 Paper Disposed on-site kg 21
3 Glass Disposed on-site kg
4 Plastic Disposed on-site kg 1
5 Aluminium Can Disposed on-site kg
6 Metal Scrap Disposed on-site kg
7 Used tyre (Ban Bekas) Disposed on-site EA
8 Other Kg

3. Energy Consumption
Month of Year 2019
NO Type of Energy Unit
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

1 Fuel For Genset Operation Liter

2 Fuel For Vehicle Liter
3 Remain Fuel Liter
4 Gasoline (liter) Liter
5 Elecricity (Genset diesel) Kva
6 Electricity (kwh) Kwh

4. Hour Meter Genset

Standard (if Month of Year 2019
NO Type Of Genset Frequensi
any)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct
 1 HT-220V (genset 1) (150Kva) Hour meter N/A
2 HT-220V (genset 2) (90 Kva) Hour meter N/A

Prepared By

…………………….
vironmental Performance

Month of Year 2019

Cummulative
Remarks
Year to Month
Dec
0
0
0
0
0
0
0
0
0

Month of Year 2019

Cummulative
Remarks
Year to Month
Dec

100
21
0
1
0
0
0
0

Month of Year 2019

Cummulative
Remarks
Year to Month
Dec

0
0
0
0
0
0

Month of Year 2019 Cummulative

Remarks
Year to Month
Nov Dec
0
0
 Laporan Environment
ENVIRONMENTAL PERFORMANCE

KONTRAKTOR : PT. PRIMA JAYA PERSADA NUSANTARA

BULAN : SEPTEMBER 2019
1. Water Consumption
Month of Year 2019 Cummulative Year
NO Activity Water Source Unit
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec to Month

Ground Water m3
1 Domestik
Surface Water m3 600
600
Ground Water m3 -
2 Others
Surface Water m3 -
Total m3 0 0 0 0 0 0 0 0 600 0 0 0 600

2. Spillage
Data Unit Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Cummulative Year to Month

Number of Spillage Number

Detail of Spillage
Type of Amount
N0 Month Date Responsibility by Description Corrective Action Status
Spillage (Liter)

Prepared by

…………………….
 Remarks

Cummulative Year to Month

Status

Page 10
KONTRAKTOR : PT. ……….
BULAN : SEPTEMBER 2019
MASUKNYA LIMB
Jenis Limbah B3 Masuk ke TPS
Tanggal Masuk
No
Limbah B3
Oli Bekas (Liter) Grease (Kg) Filter Bekas (Kg)
1-Sep-19
2-Sep-19
3-Sep-19
4-Sep-19
5-Sep-19
6-Sep-19
7-Sep-19
8-Sep-19
9-Sep-19
10-Sep-19
11-Sep-19
12-Sep-19
13-Sep-19
14-Sep-19
15-Sep-19
1 16-Sep-19
17-Sep-19
18-Sep-19
19-Sep-19
20-Sep-19
21-Sep-19
22-Sep-19
23-Sep-19
24-Sep-19
25-Sep-19
26-Sep-19
27-Sep-19
28-Sep-19
29-Sep-19
30-Sep-19

0 0 0
0 0 0
Prepared By 0 0 0

………………………….
 LAPORAN BULANAN KONTRAKTOR TAHUN 2018
NERACA LIMBAH B3

MASUKNYA LIMBAH B3
Limbah B3 Masuk ke TPS
Stock Akhir Bulan Sumber
Material Kontaminasi Lalu Limbah B3
Aki Bekas (Kg) Sludge (Kg)
(Kg)

0 0 0 0
0 0 0 0
0 0 0
8

KELUARNYA LIMBAH B3

Jumlah Maksimal
Tanggal Keluar Jenis Limbah B3 Jumlah Tujuan
Limbah B3 Penyimpanan
Limbah Keluar Limbah B3 Penyerahan
Masuk (maks. 90 hari)

-
AH B3

Bukti Nomor
Sisa LB3
Dokumen
REKAPITULASI LIMBAH B3 PERIODE APRIL 2019

Bulan ddmmyy
NO JENIS LIMBAH B3 SATUAN Sisa
Sebelumnya Masuk Keluar
Oli Bekas Liter 0
Grease Sisa kg 0
Filter Oli Bekas kg 0
Battery Bekas kg 0
Stationary(cartridge, dry battery) kg 0
Limbah Medis kg 0
Material Terkontaminasi kg 0
Tanah Terkontaminasi kg 0
Abu Insinerasi kg 0
TOTAL 0

Catatan :
Keterangan