Service Report

Berita Acara
Report to Customer
Rentokil Indonesia (RI-JK-OS-230-SE-F-8.5-06)
Ref:142143_20240203171949
A. CUSTOMER INFORMATION
Purpose of Treatment Routine Type of Premise Hospitals
Account Number 700022169 Type of Pests Covered Qty Freq
Contract Number 50051177/1 Lumnia Compact
1 12
: (LMNCOM)
Type of Premise Hospitals
Cat Control
Customer Name RS SEPATAN MULIA 0 48
: (CATC)
Contact Name IBU NOVA Fogging (Oil Based)
0 48
: (FOG)
Contact Number +622159371801
General Pest Plus
Address (Site of application) RS SEPATAN MULIA
: Ants - Other, Cockroaches - Other, Flies, Mosquito, Rodents 0 48
JL. RAYA PAKUHAJI RT 02 RW
(GPP)
01
SEPATAN Lumnia B
9 12
TANGERANG : (LMNIAB)
BANTEN MOSClean
15520 5 12
: (MOSCLN)
Site Risk Assessment
Terdapat Anak-anak/Orang Tua/Orang Cacat/Keramaian : AREA DALAM Terdapat kendaraan/forklift/mesin pengangkat : PARKIR Bahan kimia/gas/debu/uap
: AREA LUAR, AREA DALAM Mengangkat/mengangkut : AREA LUAR, AREA DALAM Adanya penghisap udara pada sistem ventilasi : AREA DALAM

B. APPLICATOR’S INFORMATION C. CUSTOMER’S SIGNATURE/COMPANY STAMP

I declare the information below is true and
I acknowledge receipt of the report below:
correct:
Signature: Signature:

FIKRI BAMBANG IRAWAN

Name Name sukandar
FIKRI BAMBANG IRAWAN
License No. Date 03-02-2024 13:46
Date 03-02-2024 13:46
Time In 13:46
Time Out 17:19
Name of other Applicators:

D. PESTICIDES APPLIED
Active Ingredient Trade Name Class Method of Total Area Total
(Conc. Diluted Solution Applied (%)) (Conc. Diluted Solution Applied (%)) Application Treated Qty Used

Brodifacoum Talon 0.005 BB (GPP) Baiting 100 gram

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Spraying 100 ml

Area Pesticide Applied

Lem Tikus Tube (GPP) Monitoring / Trapping 3 Tube

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Cold fogging 100 ml

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 Area Pesticide Applied

Cypermethrin Smash 100EC (FOG) Thermal fogging 100 ml

Area Pesticide Applied

Luminos 1 Glue 011 (LMNCOM) Monitoring / Trapping 10 Unit

Area Pesticide Applied

Brodifacoum Talon 0.005 BB (GPP) Baiting 8 gram

Area Pesticide Applied

Brodifacoum Talon 0.005 BB (GPP) Baiting 8 gram

Area Pesticide Applied

Lem Tikus Tube (GPP) Monitoring / Trapping 0.25 Tube

Area Pesticide Applied

Lem Tikus Tube (GPP) Monitoring / Trapping 0.25 Tube

Area Pesticide Applied

Luminos 1 Glue 011 (LMNCOM) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (LMNCOM) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (LMNCOM) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (LMNCOM) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (LMNCOM) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Spraying 100 ml

Area Pesticide Applied

Cypermethrin Smash 100EC (FOG) Thermal fogging 100 ml

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Cold fogging 100 ml

Area Pesticide Applied

E. PEST STATUS
Pest Level Location Found Remarks

Flying Insect Other Low - 17 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 4 LUMNIA

Houseflies Low - 11 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 4 LUMNIA

Mosquito Low - 8 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 4 LUMNIA

Flying Insect Other Low - 16 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 6 LUMNIA

Houseflies Low - 8 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 6 LUMNIA

Mosquito Low - 11 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 6 LUMNIA

Flying Insect Other Low - 19 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 3 LUMNIA

Houseflies Low - 8 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 3 LUMNIA

Mosquito Low - 11 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 3 LUMNIA

Flying Insect Other Low - 11 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 2 LUMNIA
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 Houseflies Low - 10 Internal
Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 2 LUMNIA

Mosquito Low - 8 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 2 LUMNIA

Flying Insect Other Low - 16 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 5 LUMNIA

Houseflies Low - 9 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 5 LUMNIA

Mosquito Low - 12 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 5 LUMNIA

Flying Insect Other Low - 14 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 1 LUMNIA

Houseflies Low - 0 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 1 LUMNIA

Mosquito Low - 12 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 1 LUMNIA

G. SERVICE VISIT NOTES

Product (s) Visit Notes

Lumnia B - 12

Fogging (Oil Based) - 48

Cat Control - 48

General Pest Plus - 48

MOSClean - 12

Lumnia Compact - 12

Rentokil Indonesia Komplek Pergudangan Multiguna, Duta Indah Iconic, Blok C No.37, Jl. M H Thamrin, Cikokol, Tangerang, 15117
t +622129866707/706 f e rendra.wdriyo@rentokil-initial.com w www.rentokil.co.id p myRentokil

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