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FAST . ACCURATE . PROFESSIONAL

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Komite Akreditasi Nasional
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LABORATORY TEST REPORT

Date : AugusE26,202'l Job Number : GL-O174 o
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Customer C

UNIVERSITAS BRAWIJAYA m;
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Location: {x
PT CIOMAS t (_
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Ds. Gambirono, Kec. Bangsalsari, Jember 7:

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Attention
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Mr. Hendri

Hasil uji laboratorium hanya berhubungan dengan sampte yang diuji. Dilarang merubah, menambah dan/atau mengurangi isi laporan tanpa ijin dari PT Genau Loka Cantari.
Laboratory test results are only retated to sample being tested. lt is probitied to modify the content of this report without PT Cenau Loka Gantari's appovat.

PT Genau Loka Gantari. alamat: Jambangan Kebon Agung no 12 A Surabaya 60232

telp : (031) 8251 82481828 9707,08113081 435 . email: genaulokagantari@9mai[.com
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e GENAU LAB
FAST. ACCURATE ' PROFESSIONAI
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LP-'t452-tDN

LABORATORY TEST REPORT

Customer UNIVERSITAS BRAWIJAYA Date : August 26,2021

Untuk PT CIOMAS, Ds. Gambirono,
Kec. Bangsalsari, Jember

Attn : Mr. Hendri

Job No. GL-0174

ContracVPO No. APPROVAL QUOTE

Date sample received August 18,2021

Testing period August 18,2021 toAugust 26,2021

Approved by :
PT. Genau Loka Gantari

Nurita Pusparini
Laboratory Manager
I

This repoft relates specifically to the sample (s) that were drawn and / or provided by the client or their nominated third party
solely for testing. The repofted result (s) provide no warranty or verification on the sample (s) representing any specific goods
and / or shipment and only relate to the sample as received and tested. This report was prepared solely for the use of the client
named in this reporl. Genau disclaims any and all liability for damage or injury which results in the use of the information
contained herein and accepts no responsibility for any loss, damage or liability suffered by a third party as a result of any
reliance upon or use of this report.

Page 1 of 10

PT Genau Loka Gantari. alamat: Jambangan Kebon Agung no 12 A Surabaya 60232

tetp : (031) 825'1 82481828 9707,0811 3081 435 . emait: genaulokagantari@gmail.com
 Yxax
e GENAU LAB
FAST . ACCURATE. PROFESSIONAL
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LP-'t452-tDN

SAMPLE !NFORMATION

Job No. GL-0174

Customer UNIVERSITAS BRAWIJAYA

ContracUPO No. APPROVAL QUOTE

Laboratory Customel Sample Date Time Date

No. Sampled By Coordinates
Sample lD Sample lD Matrix Sampled Sampled Received

Pintu Masuk CV Mitra Ambient Air Quality

1 GL-l174-1 16-Aug-21 10.00 1 8-Aug-21 Surya, Wirya s 08' 11'52.03" E 1 13' 31', 04.08',
Prayoga Agrisatwa (1 HouQ
Air Kran Tandon CV Mitra
2 GL-0174-2 Water Supply 16-Aug-21 10.15 18-Aug-21 Surya, Wirya s 08' 11',49.80', E 1 13" 31' 04.53',
Prayoga Agrisatwa
Pemukiman Desa Ambient Air Quality
J GL-0174-3 16-Aug-2'l "t 1.10 18-Aug-21 Surya, Wirya s 08' 12'05.02' E 1 13' 31', 15.57'
Gambirono Selatan (1 Hour)
Pemukiman Desa Ambient Air Quality
4 GL-01744 16-Aug-21 12.20 18-Aug-21 Surya, Wirya s 08' 1 1' 38.87' E 1 13" 31', 00.99'
Gambirono Utara (1 Hou0
Air Kran Rumah Warga
GL-0174-5 Water Supply 16-Aug-21 12.30 18-Aug-21 Surya, Wirya s 08' 11',38.36', E 1 13' 31', 01 .43',
(Bapak Maulana)

6 GL-o174-6 Sungai Batu Rencana Outfall Surface Water 16-Aug-21 12.40 18-Aug-21 Surya, Wirya s 08' 1'1',35.51" E 1 13' 3 1', 01 .96"

Hulu Sungai Desa

7 GL-0174-7 Surface Water 16-Aug-21 12.45 18-Aug-2'1 Surya, Wirya s 08' 1'l'36.06" E 1 13' 31' 03.84',
Gambirono (Upstream)
Hilir Sungai Desa Gambirono
8 GL-0174-8 Surface Water 16-Aug-21 12.55 18-Aug-21 Surya, Wirya s 08' 1 1' 35.66', E 113" 30'58.38'
(Downstream)

Page 2 of 10

PT Genau Loka Gantari . alamat: Jambangan Kebon Agung no 12 A Surabaya 50232

tetp : (031) 8251 82481828 9707, 0811 3081 435 . email: genaulokagantari@gmail.com