LABORATORIUM PENGUJIAN No.

Dok FPP-LAB-SIMED-018-04
PT. SURVEYOR INDONESIA CABANG MEDAN No. Revisi 00
Tgl. Terbit 25 Juni 2019
DRAFT REPORT OF ANALYSIS LINGKUNGAN
Halaman

Attachments-1 : CRT-/SIMED-XI/MFS/2020

LABORATORY ANALYSIS REPORT

Customer : PT. AAA

Address : BBB
Sample Taken :-
:
Sample Received : -
Date Of Analysis : -
Sample Matrix :-
GPS Coordinate N E
- -

NO PARAMETER UNIT STANDARD RESULT METHOD

I. Physical Properties
1 Total Suspended Solids, TSS mg/l 30 1 SNI 6989.3-2019
II. Chemical Properties
1 pH insitu pH Units 6.0 - 9.0 2 SNI 6989.11-2019
2 Biochemical Oxygen Demand, BOD5 mg/L 30 3 IKA-LL-SIMED-019 (OXITOP IS 6)
3 Chemical Oxygen Demand, COD mg/L 100 4 SNI 6989.2:2019
4 Ammonia, NH3 mg/L 10 5 IKM-LL-SIMED-012 (Spectrophotometry)
5 Oil and Grease mg/L 5 6 SNI 6989.10-2011
III. Microbiology Properties
1 Total Coliform MPN/100 ml 3000 7 Membrane Filter
Based on Miniatry of Environmental Regulation No.P.68/Menlhk/setjen/kum.1/8/2016
Method of Sampling SNI 6989.59:2008
Weather during of sampling : Sunny
The Result relate only to the samples tested and report shall not be reproduced except full,
without written approval of the laboratory

page 1 attch 1

LABORATORIUM LINGKUNGAN SURVEYOR INDONESIA

 Jl. Sunggal No.197, Medan 20122
Tel : (061) 42569565, Fax : (061) 42569564
 Attachments-1 : CRT-/SIMED-XI/MFS/2020

LABORATORY ANALYSIS REPORT

Customer : PT. AAA

Address : BBB
Sample Taken :-
:
Sample Received: -
Date Of Analysis : -
Sample Matrix :-
GPS Coordinate N E
- -

NO PARAMETER UNIT STANDARD RESULT METHOD

I. Physical Properties
1 Total Suspended Solids, TSS mg/l 30 1 SNI 6989.3-2019
II. Chemical Properties
1 pH insitu pH Units 6.0 - 9.0 2 SNI 6989.11-2019
2 Biochemical Oxygen Demand, BOD5 mg/L 30 3 IKA-LL-SIMED-019 (OXITOP IS 6)
3 Chemical Oxygen Demand, COD mg/L 100 4 SNI 6989.2:2019
4 Ammonia, NH3 mg/L 10 5 IKM-LL-SIMED-012 (Spectrophotometry)
5 Oil and Grease mg/L 5 6 SNI 6989.10-2011
III. Microbiology Properties
1 Total Coliform MPN/100 ml 3000 7 Membrane Filter
Based on Miniatry of Environmental Regulation No.P.68/Menlhk/setjen/kum.1/8/2016
Method of Sampling SNI 6989.59:2008
Weather during of sampling : Sunny
The Result relate only to the samples tested and report shall not be reproduced except full,
without written approval of the laboratory

page 1 of attch.1