Formulir Permintaan Penawaran
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Informasi Pelanggan :
Pelanggan Baru
Repeat Order
Pelanggan Lama
Permintaan Baru
Nama Pelanggan :
First Name
Last Name
nama perusahaan :
*
Alamat :
Kota
Provinsi
Kode Pos
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
negara
No.Telp/Fax/hp Pelanggan :
-
Area Code
Phone Number
*
Email
*
example@example.com
Cara Pembayaran
PO
SPK
Tunai
Sampling :
*
Sampling
Tidak Di Sampling
Lokasi Pengambilan Sample / Sampling
*
Alamat Pengambilan Sample / Sampling
*
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Next
Jenis Pengujian :
WASTE WATER ANALYSIS
wASTE WATER REGULATION:
Per MenLH No. 05/2014
Kep Gub DKI 582/1995
Kep Gub Jabar 06/1999
Perda Jateng 05/2012
Per Gub Jatim 72/2013
Per MenLH No. 05/2014
jumlah sample :
DOMESTIC WASTE WATER ANALYSIS
DOMESTIC WATER REGULATION :
PerMenLHK 68/2016
JUMLAH SAMPLE :
RIVER WATER ANALYSIS
RIVER WATER REGULATION :
PPRI 82/2001 CLASS I
PPRI 82/2001 CLASS II
PPRI 82/2001 CLASS III
PPRI 82/2001 CLASS IV
JUMLAH SAMPLE :
SEA WATER ANALYSIS
SEA WATER REGULATION:
KepMenLH 51/2004 (PELABUHAN)
KepMenLH 51/2004 (WISATA BAHARI)
KepMenLH 51/2004 (BIOTA LAUT)
JUMLAH SAMPLE :
CLEAN WATER ANALYSIS
CLEAN WATER REGULATION:
PerMenKes 416/1990
JUMLAH SAMPLE :
DRINKING WATER ANALYSIS
dRINKING WATER REGULATION:
PerMenKes 492/2010
JUMLAH SAMPLE :
AMBIENT AIR QUALITY
AMBIENT AIR QUALITY REGULATION :
PPRI No. 41/1999
Pergub Jatim 10/2009
JUMLAH SAMPLE :
INDOOR AIR QUALITY
INDOOR AIR QUALITY REGULATION :
Per Menakertrans No. 13/MEN/X/2011
JUMLAH SAMPLE :
ODOR AIR QUALITY
ODOR AIR QUALITY REGULATION :
Per Menakertrans No. 13/MEN/X/2011
JUMLAH SAMPLE :
NOISE OUTDOOR
NOISE OUTDOOR REGULATION :
KepMenLH No. 48/1996
JUMLAH SAMPLE :
NOISE INDOOR
NOISE INDOOR REGULATION :
Per Menakertrans No. 13/MEN/X/2011
JUMLAH SAMPLE :
LIGHTNING (LUX)
LIGHTNING (LUX) REGULATION :
Per Menakertrans No. 13/MEN/X/2011
JUMLAH SAMPLE :
ISBB TEST
ISBB TEST REGULATION :
Per Menakertrans No. 13/MEN/X/2011
JUMLAH SAMPLE :
GROUND VIBRATION
GROUND VIBRATION REGULATION:
KEP-49/MENLH/11/1996
JUMLAH SAMPLE :
HAND AND ARM VIBRATION
HAND AND ARM VIBRATION REGULATION :
KEP-49/MENLH/11/1996
JUMLAH SAMPLE :
WHOLE BODY VIBRATION
WHOLE BODY VIBRATION REGULATION :
KEP-49/MENLH/11/1996
JUMLAH SAMPLE :
EMISSION AIR QUALITY
EMISSION AIR QUALITY REGULATION :
PerMenLH No. 21/2008 (GENSET)
PerMenLH No. 13/2009 (GENSET)
PerMenLH No. 07/2007 (BOILER)
Kep. 13/MENLH/3/1995 Attachment V B
PerMenLH no. 05 tahun 2006 (Vehicle)
PerGub Jatim 10/2009
JUMLAH SAMPLE :
CHARACTERISTIC TEST
CHARACTERISTIC TEST REGULATION :
PerMenLH no. 05 tahun 2006 (Vehicle)
jumlah sample :
TCLP TEST
TCLP TEST REGULATION :
PP 101/2014 (attachment III)
PerMen LHK No. 55/2015
Jumlah sample :
Others
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