INTERNAL WASTE MANIFEST

For Non-Hazardous Waste

MANIFEST SAMPAH INTERNAL
Untuk Sampah Tidak Berbahaya dan Beracun
Doc Ref: TEP-930-PLA-EN-BP4- FORM-TEP-HSSE-113
0004
Cont. Doc Ref.: 870310-PTS-930- TANGGUH EXPANSION PROJECT Revision No. 01
HSE-PLA-03505 Date: 15 January 2019
Treatment/ Storage : Temporary Waste Management Facility (TWMF) – CWAA – Landfill – Scrap Laydown – Cable
Facility Storage
Fasilitas Pengolah/
Pengumpul
Waste Sources
Sumber Limbah : ………………………………………………………………………………………………………………………………………………..
Company Name
Nama Perusahaan : ………………………………………………………………………………………………………………………………………………..
Date/ Month/ Year
Tanggal/ Bulan/ Tahun : ………………………………………………………………………………………………………………………………………………..

No Type of Waste Classification Quantity Unit Note

Waste Generator Transporter Waste Receiver

Penghasil Sampah Pengangkut Penerima Limbah

*Name & Date *Name & Date *Name & Date

*Nama & Tanggal *Nama & Tanggal *Nama & Tanggal
*Note: I declare the above waste data is correct by signing this manifest form
*Catatan: Saya menyatakan data limbah di atas adalah benar dengan menandatangani form ini
Waste type and classification:
Type Classification Facility
Tipe Klasifikasi Fasilitas
Food waste, green waste (grass & leaves) Organic waste TWMF / CWAA
Sampah sisa makanan, tanaman Sampah organik
Paper, plastic bag, packaging plastic, tissue, etc. Combustible waste CWAA
Kertas, plastik kresek, plastik kemasan,tisu, dll. Sampah dapat dibakar
Wood waste, plastic water bottle, glass bottle, beverages can, jerrycan, Recyclable waste TWMF / CWAA
cardbox, etc. Sampah dapat didaur
Sampah kayu, botol kemasan air, botol kaca, kaleng minuman, jerrycan, ulang
kardus, dll.
Non-contaminated PPE & jumbo bag, PVC pipe, styrofoam, plastic and Inert Landfill
ceramic fragments, sack, food plastic for pack meal, etc.
APD & jumbo bag tidak terkontaminasi, pipa PVC, Stirofom, pecahan plastik
dan keramik, karung, plastik wadah makanan pada pack meal, dll.
CSTS - scrap, BP – scrap, cable, surplus Scrap Scrap Laydown /
CSTS - scrap, BP – scrap, kabel, surplus Cable Storage

Copy 1 - white: waste receiver (Salinan 1 - putih: penerima limbah)

Copy 2 - light red: waste generator (Salinan 2 – merah muda: penghasil limbah)