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FORMULIR PERMINTAAN PENGUJIAN SAMPEL (FPPS)
Mohon mengisi data sesuai sampel yang akan diujikan
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* Indicates required question
Email
*
Your email
Nama pengirim
*
Your answer
Personil yang dapat dihubungi (N0 Hp/Whatapp)
*
Your answer
Alamat
*
Your answer
Jenis Sampel
*
Air Permukaan
Air Payau
Ikan atau Udang
Other:
Jumlah Sampel
*
Your answer
Deskripsi Sampel (Pilih Salah Satu)
*
Sampel Fresh
Sampel Diawetkan
Air / Ikan / Udang
Sampel Fresh
Sampel Diawetkan
Air / Ikan / Udang
Deskripsi Sampel Lainnya (Jelaskan kondisi sampel secara detail)
Your answer
Bentuk
*
Cair
Padat
Other:
Berat/volume
*
Your answer
Wadah
*
Botol
Tube
Plastik Klip
Other:
Tanggal Rencanan Pengiriman Sampel Uji
*
MM
/
DD
/
YYYY
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