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FORMULIR HASILPEMERIKSAAN DIMENSIKENDARAAN ANGKUTAN BARANG

Hari/Tanggal : ...............................................................................
Tempat : ...............................................................................
CATATAN PENGUKURANDIMENSIKENDARAAN NO.:
DATAKENDARAAN
1. Nomor Kendaraan : ................................................... 2. Nomor Uji : ……………………………………………….
3. Nama Pemilik : ...................................................
4. Alamat : ...................................................
5. Merk/Type/Tahun : ................................................... 8. Nomor Rangka/Mesin : ……………………………………………….
6. Jenis/Macam : Mobil Barang/………………… 9 PabrikPembuat(Perusahaan : ……………………………………………….
Karoseri)
7. Nomor/Tgl SRUT : ...................................................
NO URAIAN BUKUUJI FISIK KETERANGAN
1. Jarak Sumbu (S1-S2) ………………….. mm ……….............……. mm ......................................................................................
(S2-S3) ………………….. mm ……….............……. mm ......................................................................................
Format Formulir 2. Lebar Total (S3-S4) ………………….. mm ……….............……. mm ......................................................................................
……….............……. mm
…………………..
mm
3. Panjang Total ………………….. mm ……….............……. mm ......................................................................................
......................................................................................
Hasil Pemeriksaan 4. Tinggi Total ………………….. mm ……….............……. mm ......................................................................................
……….............……. mm
…………………..
mm
5. F O H
......................................................................................
Dimensi Kendaraan 6. R O H ………………….. mm ……….............……. mm ......................................................................................
7. Dimensi Bak/Box/Tangki
……….............……. mm
a. Panjang
…………………..
mm
......................................................................................
Angkutan Barang b. Lebar ………………….. mm ……….............……. mm ......................................................................................
…………………..
c. Tinggi
……….............……. mm
mm
......................................................................................
8. UkuranBan
a. Sumbu I ………………….. ……….............……. ......................................................................................
b. Sumbu II ………………….. ……….............……. ......................................................................................
c. Sumbu III ………………….. ……….............……. ......................................................................................
BUKUUJI Tempat/Tgl habisuji : …………………………………..
JBB/JBKB : …………………….. kg
Berat Kendaraan : …………………….. kg Penguji ……………………………………………………….
- Sumbu I : …………………….. kg
- Sumbu II : …………………….. kg CATATAN :
- Sumbu III : …………………….. kg …………………………………………………………………..
- Sumbu IV : …………………….. kg …………………………………………………………………..
Jumlah : …………………….. kg …………………………………………………………………..
Daya Angkut Orang (…..) : …………………….. kg …………………………………………………………………..
Barang : …………………….. kg …………………………………………………………………..
JBI : …………………….. kg …………………………………………………………………..
Muatan Sumbu Terberat : …………………….. kg …………………………………………………………………..
Kelas Jalan : …………………….. …………………………………………………………………..
Peraturan Direktur Jenderal Perhubungan Darat Konfigurasi Sumbu : ……………………..
Pengemudi ........................., .................................
NoKP.4084/AJ.005/DRJD/2020 tentang Standar Penguji Penyidik Polri
Operasional Prosedur Penyelenggaraan
PenimbanganKendaraanBermotor ( …………………………... ) ( ............................ ) ( ............................ )
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