lampiran garam

7/24/2019 Lampiran Garam

1/27

Lampiran 1

D e s a : Jatisawit

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi

Pemantauan Garam Beryodium

No N a m a Alamat

1 B. Sri Ratna Rt 5/6

2 B. Meida Maya Rt 5/6

B. Ika P Rt 5/!" B. Kamsirah Rt 5/!

5 B. Robunga Rt 5/!

6 B. Tuminem Rt 6/6

# B. Sri Sudarti Rt 6/6

! B. Tati Nuraeni Rt 6/6

$ B. Siti Khodijah Rt /!

1% B. Suyatmi Rt /!

11

12

11"

15

16

1#

1!

1$

2%

21


2/27

Lampiran 1

D e s a : Ne&ara'a(a

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi


No N a m a Alamat

1 B. Winarti Rt 5/2 B. Sutini Rt "/

B. Kaswen Rt "/1

" B. Rasmi Rt "/

5 B. Maesaroh Rt "/

6 B. Suripah Rt 5/2

# B. Sugeng eni Rt 5/

! B. Nok Rt 5/"

$ B. Sri Rahayu Rt 5/"

1% B. Siti Komariyah Rt 5/"

1112

1

1"

15

16

1#

1!

1$

2%

21


3/27

Lampiran 1

D e s a : Kalieran&

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi


No N a m a Alamat

1 B. Indira !unani Rt #/#2 B. Maryati Rt #/#

B. Nuraeni Rt !/#

" B. Siti Khodijah Rt !/#

5 B. Retno Pujiati Rt !/#

6 P. Sudaryo Rt 6/#

# B. Kho"isoh Rt 6/#

! B.!usmiati Rt 6/#

$ B. Inayah Rt #/#

1% B. Sodikoh Rt #/#

1112

1

1"

15

16

1#

1!

1$

2%

21


4/27

Lampiran 1

D e s a : Lan&)ap

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi


No N a m a Alamat

1 B. Imroatun eni Rt 2/#

2 B. #ni S Rt 2/#

B. #ni Ma$ri%ah Rt 2/#

" B. Siti Mutmainah Rt 1/#

5 B. Ma%tukha Rt 1/#

6 B. &a'i"ah Rt 1/#

# B. Indah SP Rt 2/1

! B. (asripah Rt 2/1

$ B. Susi )ajarwati Rt /2

1% P. Sae%u""oh Rt /211

12

1

1"

15

16

1#

1!

1$

2%21

22


5/27

Lampiran 1

D e s a : A'isana

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi


No N a m a Alamat

1 B. )j.*aetun Rt #/

2 B. !uni Rt 1/"

B. &ika Rt /2

" B. Nur Wahidah Rt $/"

5 B. Nuryati Rt $/"

6 B. +",ah stuti Rt /"

# B. Tasjiyah Rt /"

! B. Imas Rt 6/5

$ B. )ikmatu" Khasanah Rt 6/51% B. Maesaroh Rt 6/5

11

12

1

1"

15

16

1#

1!

1$2%

21


6/27

Lampiran 1

D e s a : *en&&arutan

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi


No N a m a Alamat

1 B. Parikha Rt "/"

2 B. +"%i Rt 1/1

B. Sodikoh Rt 1/"

" B. Suharti Rt /"

5 B. Turoh Rt /1

6 B. Isti -omariyah Rt 2/1

# B. Siti Koriatun Rt 1/2

! B. Rikhanah Rt /"$ B. Komariyah Rt /"

1% B. Khurotu" eni Rt 2/1

11

12

1

1"

15

16

1#

1!1$

2%

21


7/27

Lampiran 1

D e s a : Du)u(turi

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi


No N a m a Alamat

1 B. Nany Rt 6/

2 B. #ndang Rt 2/"

B. )eni S Rt 6/"

" B. &ai'ah Rt #/"

5 B. (wi Nastiti.+ Rt /

6 B. No,i (ewi + Rt 6/

# B. gustinah Rt /6! B. Purwati Rt !/"

$ B. Suyatimah Rt !/5

1% B. Khonikmah Rt 1/"

11

12

1

1"

15

16

1#1!

1$

2%

21


8/27

Lampiran 1

D e s a : Bumiayu

Kecamatan : Bumiayu

Kabupaten : Brebes

Formulir Registrasi


No N a m a Alamat

1 B. Sugiarti Rt "/5

2 B.Ma/ri%ah Rt "/5

B. Siti nisah Rt "/5

" B. (wi Sa%itri Rt 6/5

5 B. %atonah Rt 6/5

6 B.Siti Kho"i%ah Rt 6/5# B. Khomisah Rt /5

! B. Ruminah Rt /5

$ B.)eni Isti0omah Rt /5

1% B. Nurhayati Rt /5

11

12

1

1"

15

161#

1!

1$

2%

21


9/27

+orm ,B Desa

FORMULIR PEMANTAUAN GARAM BERYODIUM

DI TINGKAT MASYARAKAT

TINGKAT DESA

*ropinsi Jawa -en&a( Desa Jatisawit

Kabupaten / )ota Brebes R-/ R. / 0

Kecamatan Bumiayu -&l *ela)sanaan A&ustus 2%1"

No

Bentu) ,aram

Nama ere) / Da&an& Nomor *en'a3taran 4D/*

7alus

:urai/Kroso)

Bata/Bri)et

*asar

warun&

-u)an&5ayur

Lain;lain

:u)up

1 2 " 5 6 # ! $ 1% 11

1 < DA8N 2 "5#1%%1%#1 < A 51%"1/%6/11%5/D/1/2%11 < A -0ARA 51%"1/ %6/ 11%5/ 2%11 < A 2"5# 1%% 626 < A 2"5# 1%% 626 < A 2"5# 1%% 626 < A 51%"1/%6/11%5/D/1/2%11 < A 51%"1/%6/11%5/D/1/2%11 < A 51%"1/%6/11%5/D/1/2%11 < A 51%"1/%6/11%5/D/1/2%11 < A 51%"1/%6/11%5/D/1/2%11 < A 51%"1/%6/11%5/D/1/2%11 < A 51%"1/%6/11%5/D/1/2%11 < A 2"5# 1%% 626 < A 2"5# 1%% 626 < A 2"5# 1%% 626 < A 2"5# 1%% 626 < A 2"5# 1%% 626

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