PT.

Lestari Banten Energi

Banten Power Plant

F ormulir Permohonan Akses PLTU Banten

B anten Power Plant Access Request Form

Responsible: person Issue Date : Revision No. : File No. PAGE

OHSS 07/04/2020 0 R01WSM26030 1 of 1

Nama Penanggung Jawab : Nur Khadijah
PIC Name
Perusahaan yang : PT. Sinarsakti Mandiri
Diundang
Invited Company
Asal Wilayah / Negara : INDONESIA
Country / Region of Origin
Jelaskan Keperluan / : SURVEY MATERIAL STORAGE PREPARATION.
Pekerjaan di PLTU
Banten
Explain the Needs / Works
in Banten Power Plant
Jumlah Orang : 3 (Tiga)
Number of People
Tanggal perkiraan tiba di : Kamis, 15 DESEMBER 2021 PUKUL 10.00 WIB
PLTU Banten
Estimated Date of Arrival in
Banten Power Plant
Perkiraan lama bekerja di : 1 HARI
PLTU Banten
Estimated length of work in
Banten Power Plant
Date: Date: Date:
Mengajukan Mengetahui (Acknowledged) Menyetujui (Approved)
(Requested) Manager:

Station Manager

PIC:
Nur Khadijah
Note (if necessary):
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