MOISTURE CONTENT

VESSEL : DATE :
CLIENT : JOB :
WET DRY WEIGHT DRY WEIGHT
WET
WEIGHT
SUB NO WEIGHT WEIGHT SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE
SAMPLE
LOT TRAY TRAY SAMPLE + TRAY + TRAY + TRAY + TRAY + TRAY + TRAY + TRAY + TRAY + TRAY + TRAY + TRAY
+ TRAY
(GRAM)
(GRAM) 21 JAM 23 JAM 25 JAM 27 JAM 29 JAM 31 JAM 33 JAM 35 JAM 37 JAM 39 JAM 41 JAM

CHECKED BY APPROVED BY

PT COTECNA INSPECTION INDONESIA ,4th Floor Gedung Graha Mustika Ratu,Jl. Gatot Subroto Kav. 74-75,Jakarta 12870, INDONESIA
Tel. +62 21 8306641 Fax. + 62 21 8306642

All business is conducted in accordance with Cotecna’s General Terms & Conditions available here:
http://www.cotecna.com/en/About-Cotecna/Terms-Conditions
 SAMPLE DISPATCH AND RECEIVAL FORM
DATE : PLACE/ORIGIN :
JOB NO. : CLIENT :
SAMPLE CODE : SAMPLE CODE : SAMPLE CODE :
SAMPLE ID : SAMPLE ID : SAMPLE ID :
SAMPLE SAMPLE SAMPLE
BAG SEAL TYPE OF BAG SEAL TYPE OF SEAL TYPE OF
WEIGHT REMARK WEIGHT REMARK BAG NO. WEIGHT REMARK
NO. NO. SAMPLE NO. NO. SAMPLE NO. SAMPLE
(KG) (KG) (KG)

Sent by Received by

Name : Name :
Detail : Detail :
Note : Lembar ini supaya selalu dibawa oleh penerima, diserahkan bersama sample ke Laboratorium

PT COTECNA INSPECTION INDONESIA ,4th Floor Gedung Graha Mustika Ratu,Jl. Gatot Subroto Kav. 74-75,Jakarta 12870, INDONESIA
Tel. +62 21 8306641 Fax. + 62 21 8306642

All business is conducted in accordance with Cotecna’s General Terms & Conditions available here:
http://www.cotecna.com/en/About-Cotecna/Terms-Conditions
 BARGING REPORT
VESSEL NAME :
CLIENT NAME : DATE LOADING :
S/L F/L C/O
NO. TUG BOAT BARGE INC QTY (MT) WEATHER REMARK
DATE HOUR DATE HOUR DATE HOUR
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL MT

PT COTECNA INSPECTION INDONESIA ,4th Floor Gedung Graha Mustika Ratu,Jl. Gatot Subroto Kav. 74-75,Jakarta 12870, INDONESIA
Tel. +62 21 8306641 Fax. + 62 21 8306642

All business is conducted in accordance with Cotecna’s General Terms & Conditions available here:
http://www.cotecna.com/en/About-Cotecna/Terms-Conditions
 SAMPLING SHIPMENT

LOT :
DATE :
VESSEL :
BARGE :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 2 3 4 5 6 7 8 9 10

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
11 12 13 14 15 16 17 18 19 20

41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
21 22 23 24 25 26 27 28 29 30

61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
31 32 33 34 35 36 37 38 39 40

10
81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0
41 42 43 44 45 46 47 48 49 50

10 10 10 10 10 10 10 10 10 11 11 11 11 11 11 11 11 11 11 12
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
51 52 53 54 55 56 57 58 59 60

12 12 12 12 12 12 12 12 12 13 13 13 13 13 13 13 13 13 13 14
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
61 62 63 64 65 66 67 68 69 70

REMARK SHIFT 1 :
:
:
SHIFT 2 :
:
:

PT COTECNA INSPECTION INDONESIA ,4th Floor Gedung Graha Mustika Ratu,Jl. Gatot Subroto Kav. 74-75,Jakarta 12870, INDONESIA
Tel. +62 21 8306641 Fax. + 62 21 8306642

All business is conducted in accordance with Cotecna’s General Terms & Conditions available here:
http://www.cotecna.com/en/About-Cotecna/Terms-Conditions