RI-JK-OS-230-SE-F-8.

5-06
Service Delivery Note - Thursday
Generated : 31/08/2023
30/09/2023
31/10/2023
31/07/2023
31/12/2023
30/11/2023
Branch : 12 - Jakarta West
Service Area : JO12 - Azral
Plan Number : 44845
Visit Date : 31/08/2023
31/07/2023
Plan Start Date : 31/08/2023
31/12/2023
30/11/2023
31/07/2023
Employee : 127974 - Azral
Time In / Contract No Premise Name Premise Address Product - Svr Cover Last Visit Next Visit Service
Time Out Date Date Visit
12:00 50123020 - 1 TOKOPEDIA CARE JL. LINGKAR LUAR BARAT NO LMNCOM 31/08/2023
30/09/2023
31/12/2023
31/10/2023
31/07/23
30/11/2023 31/08/2023
30/09/2023
31/12/2023
31/10/2023
31/07/23
30/11/2023 R
TOWER 101, RAWA BUAYA Lumnia Compact
CENGKARENG, 11740
JAKARTA BARAT, BP. IWAN,
+6281317132975
11:00 50123020 - 1 TOKOPEDIA CARE JL. LINGKAR LUAR BARAT NO PESTS 31/12/2023
30/09/2023
31/08/2023
31/10/2023
30/11/2023
31/07/23 30/11/2023
31/12/2023
31/10/2023
31/08/2023
30/09/2023
31/07/23 R
TOWER 101, RAWA BUAYA Ants - Other
CENGKARENG, 11740 Cockroaches - Other
JAKARTA BARAT, BP. IWAN, Flies,Mosquito,Rodents
+6281317132975 Cats,Snakes

Start Date & Time : Start Kilometres :

Finish Date & Time : End Kilometers :
Signature : PayCode :
Area Code :
Page 1 of 5
SERVICE REPORT Rentokil Initial
Report to Customer (Record of Pesticides Usage) Reference No : D/12/2563294/1/93
A. CUSTOMER INFORMATION RI-JK-OS-230-SE-F-8.5-06
Planned Date: 31/12/2023
31/08/2023
30/09/2023
31/10/2023
30/11/2023
31/07/2023 Purpose of Treatment : Routine
Account No : 700048023 PNOL Type of Pests Covered Qty Freq
Contract / Job No : C/50123020 1 Lumnia Compact 1 12
Service Area : JO12 General Pest - Ants - Other,Cockroaches - Other 12
Type of premises : Office buildings Flies,Mosquito,Rodents,Cats,Snakes
Plan Number : 44845
Customer's Name : TOKOPEDIA CARE TOWER
Contact Name : BP. IWAN
Contact Telephone : +6281317132975 / +6281317132975
Address Site of Application :
JL. LINGKAR LUAR BARAT NO. 101
RAWA BUAYA CENGKARENG
11740 JAKARTA BARAT

Site Risk Assessments:

Terdapat Anak-anak/Orang Tua/Orang Cacat/Keramaian : PUBLIC AREA;

B. PREPARATIONS USED
Active Ingredient Trade Name Method of Total Area Total Qty
Class
Conc. Diluted Solution Applied Conc. Diluted Solution Applied Application Treated Used
1
Area Preparations Used :
2
Area Preparations Used :
3
Area Preparations Used :
4
Area Preparations Used :
5
Area Preparations Used :
6
Area Preparations Used :
C. PEST STATUS * GP+ and PmP client, please refer to Service Binder and Service Log on site.
Pest Level Location Found Remarks
1 L/M/H
2 L/M/H
3 L/M/H
4 L/M/H
5 L/M/H
D. RECOMMENDATIONS BY RENTOKIL INITIAL
Type Recommendations

E. SERVICE VISIT NOTES

F. APPLICATOR'S INFORMATION G. CUSTOMER'S SIGNATURE /COMPANY STAMP

I declare the information above is true and correct: I acknowledge receipt of the above report
Signature : Signature :

Applicator's Name : Time In :

License No : Time Out : Company Stamp :
Treatment Date :
Name of Other Applicator(s) & License Number(s) :
Name of Customer:
Vehicle No : Date :
Rentokil Initial Jl. Raden Saleh, Kel Karang Mulya, Kec Karang Tengah, 15157 Tangerang
For any Service Issue please contact: Hotline 150808 e. ihs-custcare-id@rentokil-initial.com w.www.rentokil.co.id Page 2 of 5
SERVICE REPORT Rentokil Initial
Report to Customer
(Record of Pesticides Usage) Reference No : D/12/2563294/1/93
A. CUSTOMER INFORMATION RI-JK-OS-230-SE-F-8.5-06
Planned Date: 31/12/2023
31/10/2023
30/09/2023
31/08/2023
31/07/2023 Purpose of Treatment : Routine
Account No 30/11/2023
: 700048023 PNOL Type of Pests Covered Qty Freq
Contract / Job No : C/50123020 1 Lumnia Compact 1 12
Service Area : JO12 General Pest - Ants - Other,Cockroaches - Other 12
Type of premises : Office buildings Flies,Mosquito,Rodents,Cats,Snakes
Plan Number : 44845
Customer's Name : TOKOPEDIA CARE TOWER
Contact Name : BP. IWAN
Contact Telephone : +6281317132975 / +6281317132975
Address Site of Application :
JL. LINGKAR LUAR BARAT NO. 101
RAWA BUAYA CENGKARENG
11740 JAKARTA BARAT
Site Risk Assessments:
Terdapat Anak-anak/Orang Tua/Orang Cacat/Keramaian : PUBLIC AREA;

B. PREPARATIONS USED
Active Ingredient Trade Name Method of Total Area Total Qty
Class
Conc. Diluted Solution Applied Conc. Diluted Solution Applied Application Treated Used
1
Area Preparations Used :
2
Area Preparations Used :
3
Area Preparations Used :
4
Area Preparations Used :
5
Area Preparations Used :
6
Area Preparations Used :
C. PEST STATUS * GP+ and PmP client, please refer to Service Binder and Service Log on site.
Pest Level Location Found Remarks
1 L/M/H
2 L/M/H
3 L/M/H
4 L/M/H
5 L/M/H
D. RECOMMENDATIONS BY RENTOKIL INITIAL
Type Recommendations

E. SERVICE VISIT NOTES

F. APPLICATOR'S INFORMATION G. CUSTOMER'S SIGNATURE /COMPANY STAMP

I declare the information above is true and correct: I acknowledge receipt of the above report
Signature : Signature :

Applicator's Name : Time In :

License No : Time Out : Company Stamp :
Treatment Date :
Name of Other Applicator(s) & License Number(s) :
Name of Customer:
Vehicle No : Date :
Rentokil Initial Jl. Raden Saleh, Kel Karang Mulya, Kec Karang Tengah, 15157 Tangerang
For any Service Issue please contact: Hotline 150808 e. ihs-custcare-id@rentokil-initial.com w.www.rentokil.co.id Page 3 of 5
SERVICE REPORT Rentokil Initial
Office Copy
(Record of Pesticides Usage) Reference No : D/12/2563294/1/93
A. CUSTOMER INFORMATION RI-JK-OS-230-SE-F-8.5-06
Planned Date: 31/08/2023
31/10/2023
30/09/2023
31/12/2023
31/07/2023
30/11/2023 Purpose of Treatment : Routine
Account No : 700048023 PNOL Type of Pests Covered Qty Freq
Contract / Job No : C/50123020 1 Lumnia Compact 1 12
Service Area : JO12 General Pest - Ants - Other,Cockroaches - Other 12
Type of premises : Office buildings Flies,Mosquito,Rodents,Cats,Snakes
Plan Number 44845
Customer's Name : TOKOPEDIA CARE TOWER
Contact Name : BP. IWAN
Contact Telephone : +6281317132975 / +6281317132975
Address Site of Application :
JL. LINGKAR LUAR BARAT NO. 101
RAWA BUAYA CENGKARENG
11740 JAKARTA BARAT

Special Instructions / Call Out Remarks :

Please refer to the next page for special instruction

B. PREPARATIONS USED
Active Ingredient Trade Name Method of Total Area Total Qty
Class
Conc. Diluted Solution Applied Conc. Diluted Solution Applied Application Treated Used
1
Area Preparations Used :
2
Area Preparations Used :
3
Area Preparations Used :
4
Area Preparations Used :
5
Area Preparations Used :
6
Area Preparations Used :
C. PEST STATUS * GP+ and PmP client, please refer to Service Binder and Service Log on site.
Pest Level Location Found Remarks
1 L/M/H
2 L/M/H
3 L/M/H
4 L/M/H
5 L/M/H
D. RECOMMENDATIONS BY RENTOKIL INITIAL
Type Recommendations

E. SERVICE VISIT NOTES

F. APPLICATOR'S INFORMATION G. CUSTOMER'S SIGNATURE /COMPANY STAMP

I declare the information above is true and correct: I acknowledge receipt of the above report
Signature : Signature :

Applicator's Name : Time In :

License No : Time Out : Company Stamp :
Treatment Date :
Name of Other Applicator(s) & License Number(s) :
Name of Customer:
Vehicle No : Date :
Rentokil Initial Jl. Raden Saleh, Kel Karang Mulya, Kec Karang Tengah, 15157 Tangerang
For any Service Issue plese contact: Hotline 150808 e. ihs-custcare-id@rentokil-initial.com w.www.rentokil.co.id Page 4 of 5
 p
SERVICE REPORT Rentokil Initial
Office Copy (Record of Pesticides Usage) Reference No : D/12/2563294/1/93
A. CUSTOMER INFORMATION RI-JK-OS-230-SE-F-8.5-06
Planned Date: 30/09/2023
31/08/2023
31/10/2023
31/12/2023
30/11/2023
31/07/2023 Purpose of Treatment : Routine
Account No 700048023 Type of Pests Covered Qty Freq
Contract / Job No : C/50123020 1 PNOL Lumnia Compact 1 12
Service Area : JO12 General Pest - Ants - Other,Cockroaches - Other 12
Type of premises : Office buildings Flies,Mosquito,Rodents,Cats,Snakes
Plan Number 44845
Customer's Name : TOKOPEDIA CARE TOWER
Contact Name : BP. IWAN
Contact Telephone : +6281317132975 / +6281317132975
Address Site of Application :
JL. LINGKAR LUAR BARAT NO. 101
RAWA BUAYA CENGKARENG
11740 JAKARTA BARAT

SPECIAL INSTRUCTIONS
Product Code Special Instructions

Lumnia Compact Lite TR/Lumnia Compact/1unit/Area Dalam#

General Pest - Ants - Other,Cockroaches - Other
Flies,Mosquito,Rodents,Cats,Snakes
Lite BT/TLN(Broadifacum)/1.500gr/Area Dalam & Luar# TR/TRB2(Trays Bait
Kecil)/25unit/Area Dalam# TR/LTT(Lem Tikus)/8unit/Area Dalam# TR/PLC(Plastik
Trays)/24unit/Area Dalam# TR/PSG(Prisma Segitiga)/24unit/Area Dalam# TR/RBX(Rat
Box)/20unit/Area Luar# TR/MLT(Perangkap Tikus Massal)/4unit/Area Dalam#
BT/BLA(Imidacloprid)/15gr/Area Dalam# BT/MX2(Fipronil)/15gr/Area Dalam#
TR/HHT(Hoy-Hoy Trap)/2unit/Area Dalam# TR/PKK(Perangkap Kucing)/2unit/Area Luar#
TR/SNK(Snake Trap)/1unit/Area Luar# TR/Mosclean/1unit/Area Dalam# SP/IC1-Icon 25
EC(Lamda Cyhalothrin)/450ml/Area Dalam (Rolling Chemical)#
SP/KTH(Deltamethrin)/500ml/Area Dalam (Rolling Chemical)#
CF/SMS(Cypermethrin)/500ml/Area Dalam#

Page 5 of 5