Form Log Book Pangkalan LPG 3 KG Revisi 30 12 23

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LOGBOOK PENYALURAN PANGKALAN LPG 3 KG

Nama Pangkalan : Rumah Tangga : Tbg

No. Reg Pangkalan : Usaha Mikro Tbg


:
Alamat : Nelayan Tbg
:
No. Handphone Pangkalan : Petani Tbg
:
Nama Agen Penyuplai : Pengecer Tbg
:
Bulan : Total : Tbg

TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total

Stok Awal Tbg

Penerimaan Tbg

Paraf Supir Paraf

Nama Pembeli Kategori (√)


No Alamat Pembeli
NIK RT UM Nelayan Petani Pengecer

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf
Nama Pembeli Kategori (√)
No Alamat Pembeli
NIK RT UM Nelayan Petani Pengecer

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf
Nama Pembeli Kategori (√)
No Alamat Pembeli
NIK RT UM Nelayan Petani Pengecer

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

Tbg

NIK: Paraf

TOTAL PENJUALAN
Tbg

Stok Akhir
Tbg

Tabung Isi
Tbg

Tabung Kosong
Tbg

Tabung Bocor
Tbg

Ketarangan

NIK : Nomor Induk Kependudukan

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