Post on 24-Feb-2018
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
7/24/2019 Lampiran Garam
2/27
Lampiran 1
D e s a : Ne&ara'a(a
Kecamatan : Bumiayu
Kabupaten : Brebes
Formulir Registrasi
Pemantauan Garam Beryodium
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
7/24/2019 Lampiran Garam
3/27
Lampiran 1
D e s a : Kalieran&
Kecamatan : Bumiayu
Kabupaten : Brebes
Formulir Registrasi
Pemantauan Garam Beryodium
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
7/24/2019 Lampiran Garam
4/27
Lampiran 1
D e s a : Lan&)ap
Kecamatan : Bumiayu
Kabupaten : Brebes
Formulir Registrasi
Pemantauan Garam Beryodium
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
7/24/2019 Lampiran Garam
5/27
Lampiran 1
D e s a : A'isana
Kecamatan : Bumiayu
Kabupaten : Brebes
Formulir Registrasi
Pemantauan Garam Beryodium
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$2%
21
7/24/2019 Lampiran Garam
6/27
Lampiran 1
D e s a : *en&&arutan
Kecamatan : Bumiayu
Kabupaten : Brebes
Formulir Registrasi
Pemantauan Garam Beryodium
No N a m a Alamat
1 B. Parikha Rt "/"
2 B. +"%i Rt 1/1
B. Sodikoh Rt 1/"
" B. Suharti Rt /"
5 B. Turoh Rt /1
6 B. Isti -omariyah Rt 2/1
# B. Siti Koriatun Rt 1/2
! B. Rikhanah Rt /"$ B. Komariyah Rt /"
1% B. Khurotu" eni Rt 2/1
11
12
1
1"
15
16
1#
1!1$
2%
21
7/24/2019 Lampiran Garam
7/27
Lampiran 1
D e s a : Du)u(turi
Kecamatan : Bumiayu
Kabupaten : Brebes
Formulir Registrasi
Pemantauan Garam Beryodium
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
7/24/2019 Lampiran Garam
8/27
Lampiran 1
D e s a : Bumiayu
Kecamatan : Bumiayu
Kabupaten : Brebes
Formulir Registrasi
Pemantauan Garam Beryodium
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
7/24/2019 Lampiran Garam
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