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            6.    STIKER MEMENUHI SYARAT K3 DAN STIKER TIDAK MEMENUHI SYARAT
                  K3



                  a.    Stiker memenuhi syarat K3




                                                       KOP SURAT




                                               MEMENUHI SYARAT K3



















                NAMA PESAWAT                   :  ..................................................................................................................

                NO. SURAT KETERANGAN           :  ..................................................................................................................
                MEMENUHI SYARAT K3
                KAPASITAS                      :  .................................................................................................................

                NO. SERIE                      :  ..................................................................................................................

                TANGGAL PEMERIKSAAN DAN        :  ..................................................................................................................
                PENGUJIAN
                TANGGAL PEMERIKSAAN DAN        :  PALING LAMBAT......................................................................................
                PENGUJIAN BERIKUTNYA
                NAMA AHLI K3 / PENGAWAS        :  ..................................................................................................................
                KK SP. PAA
                NO. REG AHLI K3 SP. PAA /      :  ..................................................................................................................
                SKP PENGAWAS KK SP. PAA







                TTD AHLI K3 / PENGAWAS KK      :
                SP. PAA
   250   251   252   253   254   255   256