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                  b.    Stiker tidak memenuhi syarat K3


                                                       KOP SURAT





                                          TIDAK MEMENUHI SYARAT K3



















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

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

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

                 TANGGAL PEMERIKSAAN            :  ..................................................................................................................
                 DAN PENGUJIAN
                 SYARAT-SYARAT YANG             :  ..................................................................................................
                 HARUS DIPENUHI                   ..................................................................................................
                                                  ..................................................................................................
                                                  ..................................................................................................
                                                  ..................................................................................................
                                                  ..................................................................................................
                                                  ..................................................................................................
                                                  ..................................................................................................

                                                  PALING LAMBAT......................................................................................
                 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
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