Professional Documents
Culture Documents
Service Receipt
Service Receipt
Report
Berita Acara
Report to Customer
Rentokil Indonesia (RI-JK-OS-230-SE-F-8.5-06)
Ref:142143_20210521165530
A. CUSTOMER INFORMATION
Purpose of Treatment Routine Shared Type of Premise Hospitals
Account Number 700022169 Type of Pests Covered Qty Freq
Contract Number 50051177/1 General Pest Plus
: Ants - Other, Cockroaches - Other, Flies, Mosquito, Rodents 0 48
Type of Premise Hospitals (GPP)
Customer Name RS SEPATAN MULIA Cat Control
0 48
Contact Name IBU NOVA : (CATC)
Contact Number +622159371801
Address (Site of application) RS SEPATAN MULIA
JL. RAYA PAKUHAJI RT 02 RW
01
SEPATAN
TANGERANG
INDONESIA
15520
Site Risk Assessment
Terdapat Anak-anak/Orang Tua/Orang Cacat/Keramaian : AREA DALAM Terdapat kendaraan/forklift/mesin pengangkat : PARKIR Bahan kimia/gas/debu/uap
: AREA LUAR, AREA DALAM Mengangkat/mengangkut : AREA LUAR, AREA DALAM Adanya penghisap udara pada sistem ventilasi : AREA DALAM
B. APPLICATOR’S INFORMATION C. CUSTOMER’S SIGNATURE
I declare the information below is true and correct: I acknowledge receipt of the report below:
Signature: Signature:
FIKRI BAMBANG IRAWAN
Name Name Ibu Nova
FIKRI BAMBANG IRAWAN
21-05-2021
License No. Date
14:01
Date 21-05-2021 14:01
D. PESTICIDES APPLIED
Active Ingredient Trade Name Class Method of Total Total
(Conc. Diluted Solution (Conc. Diluted Solution Applied (%)) Application Area Qty
Applied (%)) Treated Used
Monitoring /
Luminos 1 Glue 011 (GPP) 6 Unit
Trapping
Area Pesticide Applied
Monitoring /
LEM TIKUS ULTRA SUPER (GPP) 6 Tube
Trapping
Area Pesticide Applied
F. RECOMMENDATIONS BY RENTOKIL INITIAL
Type Recommendations Priority
(CATC) saluran drainase area parkir motor harus selalu bersih,sehingga tidak terdapat
Housekeeping rerumputan dan limbah botol plastik dan lain2,agar tidak menjadi tempat berkembang biak Low
1/2
hama
G. SERVICE VISIT NOTES
Product (s) Visit Notes
Cat Control - 48
Rentokil Indonesia Komplek Pergudangan Multiguna, Duta Indah Iconic, Blok C No.37, Jl. M H Thamrin, Cikokol, Tangerang, 15117
t +622129866707/706 f e rendra.wdriyo@rentokil-initial.com w www.rentokil.co.id
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