Request Form: NO Item Name QTY Satuan Price Total Item Description

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REQUEST FORM

Request No : Request Date : 10 Januari 2022


Location Project Rsup Dr. Sardjito Request By : Riyadh

NO ITEM NAME QTY SATUAN PRICE Total ITEM DESCRIPTION


1 Roda Scafoolding 8 pcs Rp 215,000 Rp 1,720,000

2 Lakban transparan 4 pcs

3 Amplas Tipis 2 mtr

4 WD 40 2 can Rp 50,000 Rp 100,000

5 Shock Tembaga 1 1/8 10 pcs


6 Shock Tembaga 5/8 10 pcs
7 Elbow 5/8 10 pcs

8 Kunci L 1 set

9 Spidol Putih 3 pcs

10 Kawat Las RB 3 Dus


11 Sarung Tangan 3 Pack
12 Paku rivet 3 Dus
13 Paku Roofing 4 Dus

Prepared By Approved By

Riyadh El Mufid

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