No.

Dokumen : FM-RN/002
Standar : CPKB, HALAL,
ISO 9001, ISO 14001, ISO 45001, GMP
FORM PENGAJUAN
UJI CEMARAN PRODUK
Departemen : Halaman : 1 dari 1
Regulasi & Notifikasi Berlaku : 07 Januari 2023
No. Revisi : 00

Tanggal Pengajuan : 09 Januari 2023

*Status Pengajuan : Internal / Eksternal
Tempat Pengujian :
Tanggal
No. Berat Jenis
No. Nama Merek Nama Produk No. Notifikasi Pengiriman
Batch Sample Pengujian
Sampel
1 Deep Cleansing NA18211209017 0182210. 100 ml - ALT
Foam A6DCF - AKK
- Logam Berat
(Pb,Cd,Hg,As
ADLEEVA - 1,4- Dioxane
2 (2 Varian) Acne Fighter Night NA18210112011 0092209. 100 gr - ALT
Cream A6AFN - AKK
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
3 Brightening Facial NA18221201444 0062211. 100 ml - ALT
Wash B3BFW - AKK
- Logam Berat
(Pb,Cd,Hg,As
BABY PINK
- 1,4- Dioxane
SKINCARE
4 Glowing Night NA18220100745 0012101. 100 gr - ALT
(2 Varian) - AKK
Cream B3GNC
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
5 Treatment Facial NA18221200030 0042210. 100 ml - ALT
Cleanser D8TFC - AKK
D’ANDS - Logam Berat
(Pb,Cd,Hg,As
BEAUTY CARE
- 1,4- Dioxane
(2 Varian)
6 Crystal Lightening NA18220102558
Essence
7 FOR MORE Pinky Lip Serum NA18221300452 0012111. 100 gr - ALT
AUTHENTIC F6PLS - AKK
- Logam Berat
BEAUTY (Pb,Cd,Hg,As
- Hidrokuinon
8 Gbee Soft Matte NA18221301028 0032210. 100 gr - ALT
Lip Cream Nude G11MLN - AKK
GBEE GLOW - Logam Berat
Peach (Pb,Cd,Hg,As
BEAUTY
9 Gbee Soft Matte NA18221301040 0012208. 100 gr - ALT
TREATMENT - AKK
Lip Cream Pink G11MLP
- Logam Berat
Nude (Pb,Cd,Hg,As
10 LE BYEOL Shimmering Body NA18220105662 0012209. 100 gr - ALT
- AKK
Essence L6SBE - Logam Berat
(Pb,Cd,Hg,As
- Hidrokuinon
 No. Dokumen : FM-RN/002
Standar : CPKB, HALAL,
ISO 9001, ISO 14001, ISO 45001, GMP
FORM PENGAJUAN
UJI CEMARAN PRODUK
Departemen : Halaman : 2 dari 1
Regulasi & Notifikasi Berlaku : 07 Januari 2023
No. Revisi : 00

11 Rich Glow Secret NA18221202447 0012201. 100 ml - ALT

L6RGS - AKK
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
12 Intense Glow Face NA18221200365 0092211. 100 ml - ALT
Wash O2IGF - AKK
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
OSHINBEAUTY - Hidrokuinin
13 Acne Care Night NA18220101603 0012209. 100 gr - ALT
Cream 02ACN.1 - AKK
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
14 Glow & NA18211207062 0162211. 100 ml - ALT
Brighetning Liquid P2GBL - AKK
- Logam Berat
Soap (Pb,Cd,Hg,As
PHARMASKIN - 1,4- Dioxane
15 SOLUTION Glow & NA18210109464 0022109. 100 gr - ALT
Brighetning Daily P2GBD - AKK
- Logam Berat
Care (Pb,Cd,Hg,As
- 1,4- Dioxane
16 Facial Wash NA18221200361 0042208. 100 ml - ALT
T4FWA - AKK
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
THISISYOUR
17 Night Cream NA18220101790 0052112. 100 gr - ALT
T4NCR - AKK
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
18 Glowing Face NA18221202993 0042211. 100 gr - ALT
Cleanser T6GFC - AKK
- Logam Berat
(Pb,Cd,Hg,As
- 1,4- Dioxane
TOTTI GLOW
19 Sun Protecting NA18220104491 0042211. 100 gr - ALT
Brightening Day T6SPB - AKK
- Logam Berat
Cream (Pb,Cd,Hg,As
- 1,4- Dioxane
Note : - Jika mengandung Alpha Arbutin, maka WAJIB dilakukan Uji Hidrokuinon
- Jika mengandung Sodium Laureth Sulfate atau Polyethilene Glykol, maka WAJIB dilakukan
Uji 1,4-Dioksane
- * Pilih salah satu
 No. Dokumen : FM-RN/002
Standar : CPKB, HALAL,
ISO 9001, ISO 14001, ISO 45001, GMP
FORM PENGAJUAN
UJI CEMARAN PRODUK
Departemen : Halaman : 3 dari 1
Regulasi & Notifikasi Berlaku : 07 Januari 2023
No. Revisi : 00

Diajukan oleh, Diterima oleh, Diketahui oleh, Disetujui oleh,

( Reni Maryani ) ( Ronald Halomoan ) (apt. Dwi Lisnamanti, S.Farm) ( Michael Simon )
Supervisor Regulasi &
Manager Quality Control Penanggung Jawab Teknis Direktur
Notifikasi