SERVICE ORDER FORM

COMPANY NAME : RSUD DR. R. SOSODORO DJATIKOESOEMO BOJONEGORO

FESTRONIK ID :
JL. VETERAN NO. 36 BOJONEGORO No 01/DEC-2020
Address
KHLK-5729 Contract Ref. 003/PPLI-FC/VIII/2020
PIC LAPANGAN SISWO HANDOYO 445/046/412.202.1/PKS/2020
PHONE 085233192544 Quo. Ref. 377/EJTS/MKT-V/2020REV1
EMAIL dewoaj@gmail.com 25 AGUSTUS 2020
PIC FESTRONIK DIMAS AJI LANGGENG D.
Phone 081287132306 PO Ref.
Email sanitasirs36@gmail.com

Dear PPLi,
I’d like to order of waste transportation and disposal of waste as described as below :
N As contract
Profile # Waste Description Code Weight (kg)
o Qty Unit
1 Fly ash insinerator A347-1 19 DRUM 2747
Limbah Elektronik
2   (Catridge) B107D 1 LOAD 9.17
Limbah Elektronik
3 (Lampu TL) B107D 3 LOAD 26.3
4 Aki bekas A120D 2 BUAH 64
5 Batrei bekas A120D 5 LOAD 46.75
JUMLAH 2893.22
10 Transportation Charge 1 TRIP

Note :
1. Invoice based on actual received in PPLi Facility
2. Actual Packaging based on quotation reference
3. If any differences between Service Order and Quotation Letter, PPLi having authority to convert
as incoming without confirmation to the customer

Prepared and Send by

RSUD DR. R. SOSODORO DJATIKOESOEMO

Name : DONY PRASETIO SOEHARTO, SE., MM

Title : Pejabat Pelaksana Teknis Kegiatan (PPTK)