Nama Pemilik PT.

KARAWANG FOODS LESTARI

Jl. Kapuk Blok F19 No. 9, Kawasan Industri Delta Silikon 3, Lippo
Alamat Pemilik
Cikarang, Bekasi, 17530 - Indonesia
Order Code : LBF 032024/0002 Start Temperature Room :
Costumer Name : PT. Karawang Foods Lestari End Temperature Room :
Equipment Name : Laminar Air Flow Start RH Room :
Cabinet Model : Horizontal End RH Room :
Verification Status : Re - Verification Location Test :
Merk : JISICO Engineer Verification :
Type : J-CBWV2
S/N : 2101-01 Thermohygrometer :
Receipt Date : 3/12/2024
Verification Date : 3/12/2024
Additional ID : Lab Mikrobiologi
Air Velocity ; Light Intensity ;
Test Sampling :
Ultraviolet ; Noise Level

TEST 1. AIR VELOCITY 1 2 3 4 5

Position Lest Side m/s

. . . . . . Rear 0.4 0.4 0.4 0.4 0.5

. . . . . . Center 0.4 0.4 0.4 0.4 0.4

. . . . . . Front 0.4 0.4 0.3 0.4 0.4

Min Velocity : 0.3

Max Velocity : 0.5
Average Velocity : 0.41
Within Tolerance ± 20% : Pass / Fail

Acceptance Criteria
1. Average Air Velocity : 0.40 m/s ~ 0.50 m/s
2. All Individual Velocities : The Individual point readings that do not vary more than ± 20% of the

Meet Acceptance Criteria ✘ YES / PASS

( According to NSF 49 ) NO / FAIL

TEST 2. LIGHT INTENSITY TEST

From the Left Side Wall 1 2 3 4 5
Background (LUX) 6 8 10 10 9
Light On (LUX) 1187 1383 1568 1572 1451
Average Background 8.83
Average Light On 1399.83

Acceptance Criteria
Average light intensity shall be no less than 480 LUX greater than backgroung levels, where backgrou

Meet Acceptance Criteria ✘ YES / PASS

( According to NSF 49 ) NO / FAIL

TEST 3. ULTRAVIOLET LAMP TEST

Measured Lamp Intensity 80 micro watts/cm²

Acceptance Criteria
1. The measured lamp intensity should be greater than the minimum intensity of 100 micro watts/cm
2. The ultraviolet lamp should be replaced when the lamp's intensity drops to 40 micro watts/cm²

Meet Acceptance Criteria ✘ YES / PASS

( According to NSF 49 ) NO / FAIL

TEST 4. NOISE LEVEL TEST Table N-1.1 Correction chart for sound level r

Left Center Right

Difference between total Number to subtra
Measure Noise (Db)
and background sound total to yield co
57.8 53.3 55.8 readings in dbA noise leve

Acceptance Criteria 0 to 2 reduce backgroun

The measured noise level should be less than 67 dbA 3 3
4 to 5 2
Meet Acceptance Criteria ✘ YES / PASS 6 to 10 1
( According to NSF 49 ) NO / FAIL > 10 0
re Room : 24.1 °C
e Room : 24.3 °C
: 50 %
: 57 %
: On - Site
tion : Arya Pradipta

ter : TH-002

5 6

0.5 0.4

0.4 0.4

0.4 0.5

e than ± 20% of the average air velocity

6
10
1238

vels, where background light levels average a max. of 160 LUX

f 100 micro watts/cm² for a new lamp
micro watts/cm²

on chart for sound level readings

Number to subtract from

total to yield corrected
noise level

reduce background levels

3
2
1
0
Laminar Air Flow Ade Hidayat TH-001
Biosafety Cabinets Agus Apriyanto TH-002
Fume Hood TH-003
Biological Safety Cabinets Arya Pradipta TH-004
TH-005
Firdaus Farianda TH-006
TH-007
Horizontal TH-008
Vertical TH-009
TH-010
New - Verification
Re - Verification

On - Site
In - Lab
TH-001
TH-002
TH-003
TH-004
TH-005
TH-006
TH-007
TH-008
TH-009
TH-010
 ORDER CODE

PT. INTERCAL TEKNIK SOLUSINDO LBF 032024/0002

FORM VERIFICATION : Laminar Air Flow (Lab Mikrobiologi) Bio Safety Cabinet Cabinet Model New-Verification
COSTUMER NAME : PT. Karawang Food Lestari
✘ Laminar Air Flow Horizontal Vertical ✘ Re-Verification
MERK : JISICO Fume Hood
TYPE : J-CBWV2
S/N : 2101-01
DATE VERIFICATION : 3/12/2024
ROOM TEMPERATURE : 22,0 - 22,5 °C
TEST 1. AIR VELOCITY ROOM HUMIDITY : 58 - 63 %
Velocity Test Site Test Data

1 2 3 4 5 6
• • • • • •
Position Left Side
m/s m/s m/s m/s m/s m/s

• • • • • •
Rear 0.40 0.40 0.40 0.40 0.50 0.40

Center 0.40 0.40 0.40 0.40 0.40 0.40

Front 0.50 0.40 0.30 0.40 0.40 0.50

• • • •
Acceptance Criteria
1. Average Air Velocity
2. All Individual Velocities
Meet Acceptance Criteria
( According to NSF 49 )
• •
Min Velocity : 0.30 m/s
Max Velocity : 0.50 m/s
Average Velocity : 0.41 m/s
Within Tolerance ± 20% : PASS / FAIL
: 0.40 m/s ~ 0.50 m/s
: The Individual point readings that do not vary more than ± 20% of the average air velocity
✘ YES / PASS
NO / FAIL

TEST 2. LIGHT INTENSITY TEST

Test Data
From the Left Side Wall 1 2 3 4 5 6
Background (LUX) 6 8 10 10 9 10

Light On (LUX) 1187 1383 1568 1572 1451 1238

Average Background 8.83

Average Light On 1399.83

Acceptance Criteria
1. Average light intensity shall be no less than 480 LUX greater than backgroung levels, where background light levels average a max. of 160 LUX
Meet Acceptance Criteria ✘ YES / PASS
( According to NSF 49 ) ✘ NO / FAIL

TEST 3. ULTRAVIOLET LAMP TEST

Test Data
Measured Lamp Intensity 80 micro watts/cm²

Acceptance Criteria
1. The measured lamp intensity should be greater than the minimum intensity of 100 micro watts/cm² for a new lamp
2. The ultraviolet lamp should be replaced when the lamp's intensity drops to 40 micro watts/cm²
Meet Acceptance Criteria ✘ YES / PASS
( According to NSF 49 )
NO / FAIL

TEST 4. NOISE LEVEL TEST

Test Data Table N-1.1 Correction chart for sound level readings

Left Center Right Difference between total and

Number to subtract from total
Measure Noise (Db) background sound readings in
to yield corrected noise level
dbA
57.8 53.3 55.8

0 to 2 reduce background levels

Accepted Criteria 3 3

The measured noise level should be less than 67 dbA 4 to 5 2

Meet Acceptance Criteria 6 to 10 1

✘ YES / PASS
( According to NSF 49 ) NO / FAIL > 10 0