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  • Request Form - Emission Sampling

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    1. The emission sampling form is for Rumah Sakit Sumber Waras located in Jalan Urip Sumoharjo, No. 05 Kecamatan Ciwaringin – Kabupaten Cirebon, Indonesia. 2. The contact person is Wyta Yunita who can be reached by phone at 0231 (341079) or mobile at 085224550207 and by email at Ipsrs.rssw@gmail.com. 3. The sampling is for an incinerator called Burnal UM-201 that uses Pertamina Dex fuel and has a stack that is 15 meters high with a 12 cm sampling

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    1. The emission sampling form is for Rumah Sakit Sumber Waras located in Jalan Urip Sumoharjo, No. 05 Kecamatan Ciwaringin – Kabupaten Cirebon, Indonesia. 2. The contact person is Wyta Yunita who can be reached by phone at 0231 (341079) or mobile at 085224550207 and by email at Ipsrs.rssw@gmail.com. 3. The sampling is for an incinerator called Burnal UM-201 that uses Pertamina Dex fuel and has a stack that is 15 meters high with a 12 cm sampling

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    9 views2 pages

    Request Form - Emission Sampling

    Uploaded by

    uba
    1. The emission sampling form is for Rumah Sakit Sumber Waras located in Jalan Urip Sumoharjo, No. 05 Kecamatan Ciwaringin – Kabupaten Cirebon, Indonesia. 2. The contact person is Wyta Yunita who can be reached by phone at 0231 (341079) or mobile at 085224550207 and by email at Ipsrs.rssw@gmail.com. 3. The sampling is for an incinerator called Burnal UM-201 that uses Pertamina Dex fuel and has a stack that is 15 meters high with a 12 cm sampling

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    of 2

    EMISSION SAMPLING FORM

    please fill out this form and return immediately via email to sales@alsglobal.co.id or fax to 021-294
    15152

    GENERAL INFO
    Company Rumah Sakit Sumber Waras
    Jalan Urip Sumoharjo, No. 05
    Address Kecamatan Ciwaringin Kabupaten Cirebon

    Contact Person Wyta Yunita


    Mobile No.
    Phone No. 0231 (341079) 085224550207
    Email address Ipsrs.rssw@gmail.com
    Persyaratan Perizinan Incinerator
    Sampling Purpose
    Sampling Scenario Before / After
    Sampling Run Twice
    STACK
    SPECIFICATION
    Name Burnal UM - 201

    Function Incinerator

    Fuel Used Pertamina Dex

    Regulation Reference Permen LHK No : P.56/Menlhk-Setjen/2015

    Height 15 meter
    Sampling Hole Height 12 Cm

    Ducting Type Square Circle
    Inside Diameter meter
    Outside Diameter 0,3 meter
    Access to Sampling
    Hole Stair

    Sampling Platform Available
    Gas Velocity 1-2 m/s

    Flue Gas Temperature O C


    Remarks

    Request by Rumah Sakit Sumber Waras


    Date Request 20 Desember 2016
    Signature
    The ALS Laboratory Group

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