MONTHLY REPORT

ENVIRONMENT PERFORMANCE

BULAN : MMYY

LOGO

PT.XXX
Site PT. TCM

Melak

Tanggal, DDMMYY

i
 Laporan Environment Februari 2018
Environmental Performance

KONTRAKTOR : PT. XXX

BULAN : ddmmyy

1. Material and Resources

a. Refrigerant Consumption
Month of Year 2017
Cummulative Year
NO Type of Refrigerant Code Unit Remarks
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec to Month

1 Chlorodifluoromethane R22 Kg 0
2 Tetrafluoroethane R134a Kg 0
3 Trichlorodifluoromethane R11 Kg 0
4 Dichlorodifluoromethane R12 Kg 0

b. Lubricant Consumption
Month of Year 2017
Cummulative Year
NO Type of Lubricant Unit Remarks
to Month
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Lubricant Oil Liter 0

2 Lubricant Grease Kg 0

Prepared By

PIC Area
 Environmental Performance
KONTRAKTOR : PT. XXX
BULAN : ddmmyy
2. Waste Produced
a. Hazardouse Waste Produced
Month of Year 2017
Cummulative
NO Type Hazardouse Action by Mine Site Final Destination Unit Remarks
Year to Month
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Used oil (oil bekas ) Sold to waste collector liter 0
2 Remain grease (sisa grease) Incinerated on-site kg 0
3 Oli filter Disposed on-site kg 0
4 Used Battery (Accumulator) Stored on-site kg 0
5 Stationary (Cartridqe, dry battery) Disposed on-site kg 0
6 Clinical Waste kg 0
7 Contaminated matters Disposed on-site kg 0
8 Laboratory kg 0
9 Others (Pesticide waste, etc) Disposed on-site kg 0

b. Non - Hazardouse Waste Produced

Month of Year 2017 Cummulative
NO Type Non-Hazardose Waste Action by Mine Site Final Destination Unit Remarks
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year to Month

1 Domestic Disposed on-site Kg 0

2 Paper Disposed on-site kg 0
3 Glass Disposed on-site kg 0
4 Plastic Disposed on-site kg 0
5 Aluminium Can Sold to waste collector kg 0
6 Metal Scrap Sold to waste collector kg 0
7 Used tyre (Ban Bekas) Disposed on-site EA 0
8 Other Kg 0

3. Energy Consumption
Month of Year 2017
Standard Cummulative
NO Type of Energy Unit Remarks
(if any) Year to Month
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Diesel Fuel (kliter) Kiloliter N/A 0

2 Gasoline (liter) Liter N/A 0
3 Elecricity (Genset diesel) Kva N/A N/A
4 Electricity* (kwh) Kwh N/A N/A
* Electric source from 3rd party (PLN)

4. Hour Meter Genset

Standard Month of Year 2017 Cummulative
NO Type Of Genset Frequensi Remarks
(if any) Year to Month
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 HT-130V (genset 1) Hour meter N/A 0
2 HT-150V (genset 2) Hour meter N/A 0

Prepared By

PIC Area
Catatan : 1 PCS Filter bekas rata-rata diasumsikan beratnya 3 kg
1 PCS Majun bekas rata-rata diasumsikan beratnya 100 gram (0,1 kg)
1 PCS Hose bekas rata-rata diasumsikan beratnya 3 kg
1 PCS Aki bekas rata-rata diasumsikan beratnya 30 kg
1 PCS bola lampu bekas rata-rata diasumsikan beratnya 0.25 kg

1 drum = 55 pcs filter

1 drum = 750 pcs majun/Sampah Kontaminasi
1 drum = 30 pcs hose bekas
1 drum = 50 pcs bola lampu
1 drum = 200 liter oli bekas, berat jenis oli bekas = 0.9 kg/liter, 1 drum = 200 x 0.9
1 drum grease/tanah terkontaminasi = 180 kg
 Laporan Environment Februari 2018
ENVIRONMENTAL PERFORMANCE

KONTRAKTOR : PT. Runa Persada

BULAN : Februari 2018
1. Water Consumption
Month of Year 2017 Cummulative Year
NO Activity Water Source Unit Remarks
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec to Month

Ground Water m3
1 Domestik
Surface Water m3

Ground Water m3
2 Others
Surface Water m3
Total m3

2. Spillage
Data Unit Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Cummulative Year to Month

Number of Spillage Number

Detail of Spillage
Type of Amount
N0 Month Date Responsibility by Description Corrective Action Status
Spillage (Liter)

Prepared by

PIC Area
 LAPORAN BULANAN KONTRAKTOR TAHUN 2018
NERACA LIMBAH B3
KONTRAKTOR
BULAN
MASUKNYA LIMBAH B3 KELUARNYA LIMBAH B3

Jenis Limbah B3 Masuk ke TPS Sumber Jumlah Maksimal Tanggal Bukti

Tanggal Masuk Stock Akhir Bulan Jenis Limbah B3 Jumlah Tujuan
No Limbah Limbah B3 Penyimpanan Keluar Nomor Sisa LB3
Limbah B3 Lalu Keluar Limbah B3 Penyerahan
B3 Masuk (maks. 90 hari) Limbah Dokumen
Oli Bekas (Liter) Grease (Kg) Filter Bekas (Kg) Aki Bekas (Kg) Material Kontaminasi (Kg) Sludge (Kg)
3/1/2018 Oli bekas (liter)
3/2/2018
3/3/2018
3/4/2018
3/5/2018
3/6/2018
3/7/2018
3/8/2018
3/9/2018
3/10/2018
3/11/2018
3/12/2018
3/13/2018
3/14/2018
1 3/15/2018
3/16/2018
3/17/2018
3/18/2018
3/19/2018
3/20/2018
3/21/2018
3/22/2018
3/23/2018
3/24/2018
3/25/2018
3/26/2018
3/27/2018
3/28/2018
3/29/2018
3/30/2018
3/31/2018

Prepared By

PIC Area
REKAPITULASI LIMBAH B3 PERIODE Februari 2018

Bulan ddmmyy
NO JENIS LIMBAH B3 SATUAN Sisa
Sebelumnya Masuk Keluar
Oli Bekas Liter 0
Grease Sisa kg 0
Filter Oli Bekas kg 0
Battery Bekas kg 0
Stationary(cartridge, dry battery) kg 0
Limbah Media kg 0
Material Terkontaminasi kg 0
Tanah Terkontaminasi kg 0
Abu Insinerasi kg 0
TOTAL 0

Catatan : 1 PCS Filter bekas rata-rata diasumsikan beratnya 3 kg

1 PCS Majun bekas rata-rata diasumsikan beratnya 100 gram (0,1 kg)
1 PCS Hose bekas rata-rata diasumsikan beratnya 3 kg
1 PCS Aki bekas rata-rata diasumsikan beratnya 30 kg
1 PCS bola lampu bekas rata-rata diasumsikan beratnya 0.25 kg

1 drum = 55 pcs filter

1 drum = 750 pcs majun/Sampah Kontaminasi
1 drum = 30 pcs hose bekas
1 drum = 50 pcs bola lampu
1 drum = 200 liter oli bekas, berat jenis oli bekas = 0.9 kg/liter, 1 drum = 200 x 0.9
1 drum grease/tanah terkontaminasi = 180 kg
 Keterangan

tnya 100 gram (0,1 kg)

beratnya 0.25 kg

s = 0.9 kg/liter, 1 drum = 200 x 0.9