LABORATORIUM PENGUJIAN No.

Dok FPP-LAB-SIMED-018-04
PT. SURVEYOR INDONESIA CABANG MEDAN No. Revisi 00
Tgl. Terbit 25 Juni 2019
DRAFT REPORT OF ANALYSIS LINGKUNGAN
Halaman

Attachments-1 : CRT-/SIMED-IX/MFS/2020

LABORATORY ANALYSIS REPORT

Customer : PT AAA
Address : JL. AAA
Sample Taken :-
:-
Sample Received :-
Date Of Analysis :-
Sample Matrix : Liquid
GPS Coordinate N E
- -

STANDARD
NO PARAMETER UNIT RESULT METHOD
class 1 Class II Class III Class IV
I. Physical Properties
1 Temperature °C deviasi 3 deviasi 3 deviasi 3 deviasi 5 1 SNI 06-6989.23:2005
2 Total Dissolved Solids, TDS mg/L 1000 1000 1000 2000 2 IKA-LL-SIMED-022 (Electrode)
3 Total Suspended Solids, TSS mg/L 50 50 400 400 3 SNI 6989.3:2019
II. Chemical Properties
1 pH pH Units 6-9 6-9 6-9 6-9 4 SNI 6989.11:2019
2 Biochemical Oxygen Demand, BOD5 mg/L 2 3 6 12 5 IKA-LL-SIMED-019 (OXITOP IS 6)
3 Chemical Oxygen Demand, COD mg/L 10 25 50 100 6 SNI 6989.2:2019
4 Dissolved Oxygen, DO mg/L 6 4 3 0 7 IKA-LL-SIMED-024 (Electrode)
5 Total Phospat mg/L 0.2 0.2 1 5 8 IKM-LL-SIMED-013 (Spectrophotometry)
6 Nitrate, NO3-N mg/L 10 10 20 20 9 IKM-LL-SIMED-004 (Spectrophotometry)
7 Ammonia, NH3-N mg/L 0.5 (-) (-) (-) 10 IKM-LL-SIMED-012 (Spectrophotometry)
8 Arsenic, As mg/L 0.05 1 1 1 11 APHA 23rd ed.3120 B, 2017
9 Cobalt, Co mg/L 0.2 0.2 0.2 0.2 12 APHA 23rd ed.3120 B, 2017
10 Barium, Ba mg/L 1 (-) (-) (-) 13 APHA 23rd ed.3120 B, 2017
11 Boron, B mg/L 1 1 1 1 14 APHA 23rd ed.3120 B, 2017
12 Selenium, Se mg/L 0.01 0.05 0.05 0.05 15 APHA 23rd ed.3120 B, 2017
13 Cadmium, Cd mg/L 0.01 0.01 0.01 0.01 16 APHA 23rd ed.3120 B, 2017
14 Hexavalent Chromium, Cr 6+
mg/L 0.05 0.05 0.05 1 17 IKM-LL-SIMED-005 (Spectrophotometry)
15 Copper, Cu mg/L 0.02 0.02 0.02 0.2 18 APHA 23rd ed.3120 B, 2017
16 Iron, Fe mg/L 0.3 (-) (-) (-) 19 APHA 23rd ed.3120 B, 2017
17 Lead, Pb mg/L 0.03 0.03 0.03 1 20 APHA 23rd ed.3120 B, 2017
18 Manganese, Mn mg/L 0.1 (-) (-) (-) 21 APHA 23rd ed.3120 B, 2017
19 Mercury, Hg mg/L 0.001 0.002 0.002 0.005 22 APHA 23rd ed.3120 B, 2017
20 Zinc, Zn mg/L 0.05 0.05 0.05 2 23 APHA 23rd ed.3120 B, 2017
21 Cloride, Cl- mg/L 600 (-) (-) (-) 24 IKM-LL-SIMED-015 (Spectrophotometry)
22 Cyanide, CN mg/L 0.02 0.02 0.02 (-) 25 IKM-LL-SIMED-016 (Spectrophotometry)
23 Fluoride, F mg/L 0.5 1.5 1.5 (-) 26 APHA 4500-F-E
24 Nitrite, NO2-N mg/L 0.06 0.06 0.06 (-) 27 IKM-LL-SIMED-017 (Spectrophotometry)
25 Sulfat, SO4 mg/L 400 (-) (-) (-) 28 APHA 4500-SO42-

26 Free Chlorine, Cl2 mg/L 0.03 0.03 0.03 (-) 29 IKM-LL-SIMED-018 (Spectrophotometry)
27 Hydrogen Sulfida, H2S mg/L 0.002 0.002 0.002 (-) 30 IKM-LL-SIMED-014 (Spectrophotometry)
28 Oil and Grease ɥg/L 1000 1000 1000 (-) 31 SNI 6989.10:2011
29 Surfactants, MBAS ɥg/L 200 200 200 (-) 32 SNI 06-6989.51:2005
30 Phenol ɥg/L 1 1 1 (-) 33 APHA 5530 C+D:2012
III. Microbiology Properties
1 Total Coliform Jml/100 ml 1000 5000 10000 10000 34 Membrane Filter
Based on Government Regulation No.82 year 2001
Method of Sampling SNI 6989.57:2008
Weather during of sampling : Sunny
For metal measurement it is read as dissolved metal
The Result relate only to the samples tested and report shall not be reproduced except full,
without written approval of the laboratory

page 1 of attch 1

LABORATORIUM LINGKUNGAN SURVEYOR INDONESIA

LABORATORY ANALYSIS REPORT

Customer : PT AAA
Address : JL. AAA
Sample Taken :-
:-
Sample Received :-
Date Of Analysis :-
Sample Matrix : Liquid
GPS Coordinate N E
- -

STANDARD
NO PARAMETER UNIT RESULT METHOD
class 1 Class II Class III Class IV
I. Physical Properties
1 Temperature °C deviasi 3 deviasi 3 deviasi 3 deviasi 5 1 SNI 06-6989.23:2005
2 Total Dissolved Solids, TDS mg/L 1000 1000 1000 2000 2 IKA-LL-SIMED-022 (Electrode)
3 Total Suspended Solids, TSS mg/L 50 50 400 400 3 SNI 6989.3:2019
II. Chemical Properties
1 pH pH Units 6-9 6-9 6-9 6-9 4 SNI 6989.11:2019
2 Biochemical Oxygen Demand, BOD5 mg/L 2 3 6 12 5 IKA-LL-SIMED-019 (OXITOP IS 6)
3 Chemical Oxygen Demand, COD mg/L 10 25 50 100 6 SNI 6989.2:2019
4 Dissolved Oxygen, DO mg/L 6 4 3 0 7 IKA-LL-SIMED-024 (Electrode)
5 Total Phospat mg/L 0.2 0.2 1 5 8 IKM-LL-SIMED-013 (Spectrophotometry)
6 Nitrate, NO3-N mg/L 10 10 20 20 9 IKM-LL-SIMED-004 (Spectrophotometry)
7 Ammonia, NH3-N mg/L 0.5 (-) (-) (-) 10 IKM-LL-SIMED-012 (Spectrophotometry)
8 Arsenic, As mg/L 0.05 1 1 1 11 APHA 23rd ed.3120 B, 2017
9 Cobalt, Co mg/L 0.2 0.2 0.2 0.2 12 APHA 23rd ed.3120 B, 2017
10 Barium, Ba mg/L 1 (-) (-) (-) 13 APHA 23rd ed.3120 B, 2017
11 Boron, B mg/L 1 1 1 1 14 APHA 23rd ed.3120 B, 2017
12 Selenium, Se mg/L 0.01 0.05 0.05 0.05 15 APHA 23rd ed.3120 B, 2017
13 Cadmium, Cd mg/L 0.01 0.01 0.01 0.01 16 APHA 23rd ed.3120 B, 2017
14 Hexavalent Chromium, Cr 6+
mg/L 0.05 0.05 0.05 1 17 IKM-LL-SIMED-005 (Spectrophotometry)
15 Copper, Cu mg/L 0.02 0.02 0.02 0.2 18 APHA 23rd ed.3120 B, 2017
16 Iron, Fe mg/L 0.3 (-) (-) (-) 19 APHA 23rd ed.3120 B, 2017
17 Lead, Pb mg/L 0.03 0.03 0.03 1 20 APHA 23rd ed.3120 B, 2017
18 Manganese, Mn mg/L 0.1 (-) (-) (-) 21 APHA 23rd ed.3120 B, 2017
19 Mercury, Hg mg/L 0.001 0.002 0.002 0.005 22 APHA 23rd ed.3120 B, 2017
20 Zinc, Zn mg/L 0.05 0.05 0.05 2 23 APHA 23rd ed.3120 B, 2017
21 Cloride, Cl- mg/L 600 (-) (-) (-) 24 IKM-LL-SIMED-015 (Spectrophotometry)
22 Cyanide, CN mg/L 0.02 0.02 0.02 (-) 25 IKM-LL-SIMED-016 (Spectrophotometry)
23 Fluoride, F mg/L 0.5 1.5 1.5 (-) 26 APHA 4500-F-E
24 Nitrite, NO2-N mg/L 0.06 0.06 0.06 (-) 27 IKM-LL-SIMED-017 (Spectrophotometry)
25 Sulfat, SO4 mg/L 400 (-) (-) (-) 28 APHA 4500-SO42-

26 Free Chlorine, Cl2 mg/L 0.03 0.03 0.03 (-) 29 IKM-LL-SIMED-018 (Spectrophotometry)
27 Hydrogen Sulfida, H2S mg/L 0.002 0.002 0.002 (-) 30 IKM-LL-SIMED-014 (Spectrophotometry)
28 Oil and Grease ɥg/L 1000 1000 1000 (-) 31 SNI 6989.10:2011
29 Surfactants, MBAS ɥg/L 200 200 200 (-) 32 SNI 06-6989.51:2005
30 Phenol ɥg/L 1 1 1 (-) 33 APHA 5530 C+D:2012
III. Microbiology Properties
1 Total Coliform Jml/100 ml 1000 5000 10000 10000 34 Membrane Filter
Based on Government Regulation No.82 year 2001
Method of Sampling SNI 6989.57:2008
Weather during of sampling : Sunny
For metal measurement it is read as dissolved metal

page 1 of attch.1
The Result relate only to the samples tested and report shall not be reproduced except full,
without written approval of the laboratory

page 1 of attch.1