LAMPIRANSPESIFIKASI UMUM 2018

LAMPIRAN 1.17 : TABEL RENCANA KERJA PEMANTAUAN LINGKUNGAN (RKPL)

C o n to h t a b e l r e n c a n a k e r j a p e m a n t a u a n l i n g k u n g a n

S IS I K IR I
D am pak K e g ia ta n y a n g
L in g k u n g a n M e n im b u lk a n
D am pak
1 2
.............. [S e b u tk a n .............. [ S e b u tk a n
dam pak yang k e g ia t a n y a n g
d it im b u lk a n ] .......... m enyebabkan
C o n to h : tim b u ln y a
P e n c e m a ra n u d a ra d a m p a k ] ............
(d e b u ) d a n C o n to h :
k e b is in g a n , e m is i M o b ilis a s i a la t
gas b u an g b e ra t d a n
m a te r ia l
D s t ................
P e m a n ta u a n
L in g k u n g a n
3 4
.......... [ S e b u tk a n
p e m a n ta u a n
li n g k u n g a n d a n
to lo k
u k u r /b a k u
m u tu y a n g a d a
d a la m
dokum en
lin g k u n g a n ,
SK K LH
d a n /a ta u iz in
lin g k u n g a n
u n tu k
m e m in im a lis ir
dam pak
t e r s e b u t ] ............
C o n to h :
P e n g u k u ra n
k u a lita s u d a r a
d a n k e b is in g a n ,
dengan
m engacu pada
P P 4 1 /9 9 9
J a la n S IS I K A N A N
R o n a A w al STA R o n a A w al P e m a n ta u a n K e g ia ta n y a n g D am pak
L in g k u n g a n M e n im b u lk a n L in g k u n g a n
D am pak
5 6 7 8 9
.......... [S e b u tk a n .......... [S e b u tk a n .......... [ S e b u tk a n .......... [ S e b u tk a n .............. [S e b u tk a n .............. [S e b u tk a n
k o n d is i ro n a lo k a s i/S T A y a n g k o n d is i r o n a p e m a n ta u a n k e g ia t a n y a n g dam pak yang
a w a l d a n /a ta u a k a n d il a k u k a n a w a l d a n /a ta u li n g k u n g a n m enyebabkan d it im b u lk a n ] ..........
k e g ia t a n d i p e n g e l o l a a n ] ......... k e g ia t a n d i y a n g a d a d a la m tim b u ln y a C o n to h :
s e k ita r C o n to h : 0 + 0 0 0 s e k ita r dokum en d a m p a k ] ............ P e n c e m a ra n u d a ra
l o k a s i ] ......... s /d 0 + 1 0 0 l o k a s i ] ......... lin g k u n g a n , C o n to h : (d e b u ) d a n
C o n to h : C o n to h : SK K LH M o b ilis a s i a la t k e b is in g a n , e m is i
T em pat T em pat d a n /a ta u iz i n b e ra t d an gas b u an g
tin g g a l, te m p a t tin g g a l, te m p a t li n g k u n g a n m a te ria l
usaha, p ohon- usaha, p o h o n - u n tu k
pohon dan pohon dan m e m in im a lis ir
ta n a m a n ta n a m a n dam pak
w a rg a , u tilita s w a rg a , u tilita s t e r s e b u t ] ............
C o n to h :
P en g u k u ra n
k u a lita s u d a r a
d a n k e b is in g a n

Lampiran 1.17 - 6
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