Tgl Cetak Tgl Pengiriman No. RWB 1 03/01/2011 027/02270 ... - LKPP
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Tgl Cetak Tgl Pengiriman No. RWB 1 03/01/2011 027/02270 ... - LKPP

Tgl Cetak Tgl Pengiriman No. RWB 1 03/01/2011 027/02270 ... - LKPP

Tgl Cetak Tgl Pengiriman No. RWB 1 03/01/2011 027/02270 ... - LKPP

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<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/<strong>02270</strong>/Setwan/2<strong>01</strong>0 Sekretariat DPRD Prov. Sumsel 25/02/11 04/<strong>03</strong>/11 15256661200022 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/5<strong>03</strong>9/Adm.Pemb. Setda Kab Badung 25/02/11 <strong>03</strong>/<strong>03</strong>/11 15402289800093 05/<strong>01</strong>/2<strong>01</strong>1 600/2467A/DBM Dinas Bina Marga - Pemprov. Sulawesi Selatan 19/04/11 26/04/11 15616185900044 05/<strong>01</strong>/2<strong>01</strong>1 B.02/PKRI/KI.430/I/2<strong>01</strong>1 Pusat Karantina Ikan - Kementerian KP 25/02/11 04/<strong>03</strong>/11 15402289400<strong>03</strong>5 05/<strong>01</strong>/2<strong>01</strong>1 420/0850/307/2<strong>01</strong>0 RSUD dr. Soedono - Pemprov Jatim 19/04/11 26/04/11 15616186000006 05/<strong>01</strong>/2<strong>01</strong>1 UM/02.05-Bt/151Direktorat Bina Teknik Dirjend Bina Marga -Kementerian PU25/02/11 09/<strong>03</strong>/11 154<strong>02270</strong>600097 10/<strong>01</strong>/2<strong>01</strong>1 Um.0<strong>01</strong>/1/7/Ro.5/KKP/2<strong>01</strong>1 Kementerian Kebudayaan dan Pariwisata 25/02/11 09/<strong>03</strong>/11 '1540227<strong>01</strong>00048 10/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/2996-BKPP Setda Pemerintah Kota Bogor 25/02/11 22/06/11 16164061600<strong>03</strong>9 10/<strong>01</strong>/2<strong>01</strong>1 008/D-II/<strong>01</strong>/2<strong>01</strong>1Deputi Bidang Monitoring Evaluasi danPengembangan SI25/02/11 09/<strong>03</strong>/1110 10/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/1658-sekret Dinas ESDM - Pemkab Bogor 25/02/11 08/<strong>03</strong>/11 154022712000<strong>01</strong>1 10/<strong>01</strong>/2<strong>01</strong>1 - an Herison & Hercules Marpaung 25/02/11 04/<strong>03</strong>/11 15402289600<strong>01</strong>12 10/<strong>01</strong>/2<strong>01</strong>1 873/152/408.16/2<strong>01</strong>0 Setda Pemkab - Pacitan 25/02/11 <strong>03</strong>/<strong>03</strong>/11 152566640000513 10/<strong>01</strong>/2<strong>01</strong>1 441.3/72/UP/RSJ/2<strong>01</strong>1 RSJ DAERAH - PEMPROV JAMBI 25/02/11 09/<strong>03</strong>/11 '154<strong>02270</strong>9000614 10/<strong>01</strong>/2<strong>01</strong>1 SEK.DL.06.05-27 Sekjend - Kementerian Hukum dan HAM RI 25/02/11 <strong>03</strong>/<strong>03</strong>/11 152566641000415 10/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/1299IC/Set/2<strong>01</strong>0Badan Pemberdayaan Perempuan dan KB PemprovJabar25/02/11 <strong>03</strong>/<strong>03</strong>/11 152566648000716 10/<strong>01</strong>/2<strong>01</strong>1 800/8575/2<strong>01</strong>0 Badan Kepegawaian Daerah - Pemkot Surakarta 25/02/11 09/<strong>03</strong>/11 154<strong>02270</strong>5000<strong>01</strong>7 10/<strong>01</strong>/2<strong>01</strong>1 UM.<strong>01</strong>.<strong>03</strong> - SI/682.2 Pusdiklat - Sekjend Kementerian PU 25/02/11 <strong>03</strong>/<strong>03</strong>/11 152566638000<strong>01</strong>8 10/<strong>01</strong>/2<strong>01</strong>1 06/PPB/PL.110.D2/I/2<strong>01</strong>1 Dirjend Perikanan Budidaya - Kementerian KP 26/02/11 08/<strong>03</strong>/11 '15402271100<strong>01</strong>19 10/<strong>01</strong>/2<strong>01</strong>1 35/PL.330/K1.2/I/2<strong>01</strong>1Sekretariat Dirjend Tanaman Pangan - kementerianPertanian26/02/11 18/<strong>03</strong>/11 154022753000720 10/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/178/416-021/2<strong>01</strong>0 Setda pemkab Mojokerto 26/02/11 <strong>03</strong>/<strong>03</strong>/11 152566643000221 10/<strong>01</strong>/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/XII/2<strong>01</strong>0 Dinas PU Pemprov NTT 26/02/11 09/<strong>03</strong>/11 '154022713000922 10/<strong>01</strong>/2<strong>01</strong>1 <strong>01</strong>/Keu/KR.III/11 BKN Kantor Regional III 26/02/11 09/<strong>03</strong>/11 '154<strong>02270</strong>200<strong>03</strong>Hal 1

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>45 17/<strong>01</strong>/2<strong>01</strong>1 600/18/BKP/2<strong>01</strong>1 Badan Ketahanan Pangan - Pemkab Musi Banyuasin 23/<strong>03</strong>/11 05/04/11 156161643000546 17/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/<strong>01</strong>7/Pemb. Setda - Pemkab Kendal 23/<strong>03</strong>/11 30/<strong>03</strong>/11 '156161540000947 17/<strong>01</strong>/2<strong>01</strong>1 <strong>01</strong>90/h6.7.1/FMIPA/TU/2<strong>01</strong>1 Fakultas MIPA - Universitas Padjajaran - Kemendiknas 23/<strong>03</strong>/11 22/06/11 16164062300<strong>03</strong>48 17/<strong>01</strong>/2<strong>01</strong>1 B.50/PU/Sektr./600/<strong>01</strong>/2<strong>01</strong>1 Dinas PU - Pemkab Tabalong 23/<strong>03</strong>/11 30/<strong>03</strong>/11 '156161547000249 17/<strong>01</strong>/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/I/2<strong>01</strong>0 Dinas PU - Pemprov NTT 23/<strong>03</strong>/11 30/<strong>03</strong>/11 '156161557000950 17/<strong>01</strong>/2<strong>01</strong>1 600/023/DPU/2<strong>01</strong>1 Dinas PU - Pemkab Hulu Sungai Utara 23/<strong>03</strong>/11 <strong>03</strong>/<strong>03</strong>/11 156161507000451 17/<strong>01</strong>/2<strong>01</strong>1 S-02/WPJ.10/KP.11/2<strong>01</strong>152 17/<strong>01</strong>/2<strong>01</strong>1 <strong>01</strong>.11.7/psdkp 0.2.1/tu.210/i/2<strong>01</strong>1KPP Pratama Blora - Kanwil DJP Jateng II - DirjendPajak - Kementerian KeuanganDirjend Pengawasan Sumberdaya Kelautan danPerikanan - Kementerian Kelautan dan Perikanan23/<strong>03</strong>/11 <strong>01</strong>/04/11 15616157900<strong>01</strong>16/<strong>03</strong>/11 <strong>01</strong>/04/11 156161583000453 17/<strong>01</strong>/2<strong>01</strong>1 S.104/BPDAS.Tdo-1/2<strong>01</strong>1Balai pengelolaan DAS Tondano - Dirjend PengelolaanDAS dan Perhutanan Sosial - Kemenhut18/<strong>03</strong>/11 <strong>01</strong>/04/11 156161589000854 17/<strong>01</strong>/2<strong>01</strong>1 521/<strong>01</strong>2/PKKP/I/2<strong>01</strong>1Dinas pertanian kehutanan kelautan dan perikanan -Pemkab. Sabu Raijua23/<strong>03</strong>/11 <strong>01</strong>/04/11 15616158400<strong>03</strong>55 17/<strong>01</strong>/2<strong>01</strong>1 26/X/1/5/2<strong>01</strong>1 Lembaga Administrasi Negara (LAN) 16/<strong>03</strong>/11 31/<strong>03</strong>/11 156161505000656 17/<strong>01</strong>/2<strong>01</strong>1 SC.5.12/4967/I/11Southeast Asian Ministers of education Organization(SEAMEO) Regional Open Learning Centre(SEAMOLEC)23/<strong>03</strong>/11 05/04/11 156161625000957 17/<strong>01</strong>/2<strong>01</strong>1 224/L5/KP/2<strong>01</strong>1 Kantor Koordinasi PTS Wil V DIY - Kemendiknas 23/<strong>03</strong>/11 <strong>01</strong>/04/11 156161581000658 17/<strong>01</strong>/2<strong>01</strong>1 S-12/WPJ.26/KP.02<strong>01</strong>/2<strong>01</strong>1KPP Pratama Kisaran - Kanwil DJP Sumut II - DirjendPajak - Kement.Keuangan23/<strong>03</strong>/11 12/04/11 156161665000759 17/<strong>01</strong>/2<strong>01</strong>1 050/<strong>01</strong>18 Setda Pemkab Tegal 23/<strong>03</strong>/11 22/06/11 161640604000860 17/<strong>01</strong>/2<strong>01</strong>1 007/KP/I/2<strong>01</strong>1/22 Pusdiklat Kemenlu RI 23/<strong>03</strong>/11 12/04/11 156161668000461 17/<strong>01</strong>/2<strong>01</strong>1 - an. Budianto Persyaratan tidak lengkap62 17/<strong>01</strong>/2<strong>01</strong>1 602/040/405.14/2<strong>01</strong>1 Dinas PU - Pemkab Ponorogo 28/<strong>03</strong>/11 22/06/11 161640627000963 17/<strong>01</strong>/2<strong>01</strong>1 640/04/DPU/2<strong>01</strong>1 Dinas PU Pemkab Batang Hari 23/<strong>03</strong>/11 <strong>01</strong>/04/11 156161587000064 17/<strong>01</strong>/2<strong>01</strong>1 826/1358.1/Bm Dinas PU Binamarga - Pemkab Cianjur <strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '1540228510008Hal 3

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>65 17/<strong>01</strong>/2<strong>01</strong>1 B.10.<strong>01</strong>/BBAT-MDG/PL.610/I/2<strong>01</strong>166 17/<strong>01</strong>/2<strong>01</strong>1 421/2746/Dindik/Binprog/2<strong>01</strong>0Balai Budidaya Air Tawar Mandiangin - DirjendPerikanan Budidaya - Kementerian KPDinas Pendidikan Pemprov Kepulauan BangkaBelitung23/<strong>03</strong>/11 <strong>01</strong>/04/11 1561615760004<strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 154022754000667 17/<strong>01</strong>/2<strong>01</strong>1 <strong>01</strong>/9.2-100/I/2<strong>01</strong>1 Badan Pertanahan Nasional (BPN) 31/<strong>03</strong>/11 22/06/11 161640607000568 17/<strong>01</strong>/2<strong>01</strong>1 - an. Buyung Radjiloen <strong>01</strong>/<strong>03</strong>/11 <strong>01</strong>/04/11 156161588000969 17/<strong>01</strong>/2<strong>01</strong>1 800/Setda-KK/<strong>01</strong>/06/I/2<strong>01</strong>1 Setda Pemkot Kotamobagu 16/<strong>03</strong>/11 <strong>01</strong>/04/11 15616158500<strong>027</strong>0 17/<strong>01</strong>/2<strong>01</strong>1 781/Bang/2<strong>01</strong>0 Setda Pemkab Pasaman <strong>01</strong>/<strong>03</strong>/11 <strong>03</strong>/<strong>03</strong>/11 15256664200<strong>03</strong>71 17/<strong>01</strong>/2<strong>01</strong>1 - an. Ari Sylviana <strong>01</strong>/<strong>03</strong>/11 09/<strong>03</strong>/11 '15402271000<strong>027</strong>2 24/<strong>01</strong>/2<strong>01</strong>1 522/DS3/404.112/2<strong>01</strong>1 Dinas Kehutanan dan Perkebunan - Pemkab Ngawi 23/<strong>03</strong>/11 <strong>01</strong>/04/11 15616157700<strong>03</strong>73 24/<strong>01</strong>/2<strong>01</strong>1 602/84/435.110/2<strong>01</strong>174 24/<strong>01</strong>/2<strong>01</strong>1 22/SJ-IND.6.20/I/2<strong>01</strong>175 24/<strong>01</strong>/2<strong>01</strong>1 B-82/KP3K.0/I/2<strong>01</strong>1Dina PU Cipta Karya dan Tata Ruang - PemkabSumenepBadiklat industri regional III - Pusdiklat industriKemenperindDirjend kelautan, pesisir dan pulau-pulau kecil,Kementerian KP<strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '154022854000523/<strong>03</strong>/11 22/06/11 161640611000823/<strong>03</strong>/11 <strong>01</strong>/04/11 156161590000476 24/<strong>01</strong>/2<strong>01</strong>1 600/PU/06 Dinas PU Pemkab Bintan <strong>01</strong>/<strong>03</strong>/11 12/04/11 15616164600<strong>027</strong>7 24/<strong>01</strong>/2<strong>01</strong>1 100/31/Tu-Pimp Setda Pemkab Panajam Paser Utara 23/<strong>03</strong>/11 22/06/11 161640605000778 24/<strong>01</strong>/2<strong>01</strong>1 IK.07.05-63/SKPD-TP/Pjj-PG/2<strong>01</strong>0an. Sahroni (Dinas Bina Marga Prov.Lampung -Dirjend Binamarga Kementerian PU)<strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '154022852000779 24/<strong>01</strong>/2<strong>01</strong>1 620/009/Dis.PU/BIE/2<strong>01</strong>1 Dinas PU Pemkab Balangan <strong>01</strong>/<strong>03</strong>/11 09/<strong>03</strong>/11 '154022724000580 24/<strong>01</strong>/2<strong>01</strong>1 600/12/DPU/I/2<strong>01</strong>1 Dinas PU Pemkab Sumbawa Barat <strong>01</strong>/<strong>03</strong>/11 09/<strong>03</strong>/11 '154022718000481 24/<strong>01</strong>/2<strong>01</strong>1 B.55/SJ.3/TU.210/I/2<strong>01</strong>1 Setjend Kementerian KP 18/<strong>03</strong>/11 12/04/11 15616164700<strong>01</strong>82 24/<strong>01</strong>/2<strong>01</strong>1 181/H.19/TU/2<strong>01</strong>1 Universitas Riau - Kemendiknas 18/<strong>03</strong>/11 12/04/11 156161650000583 24/<strong>01</strong>/2<strong>01</strong>1 B/119/I/2<strong>01</strong>1/BNN Badan Narkotika Nasional (BNN) RI 18/<strong>03</strong>/11 12/04/11 156161662000084 24/<strong>01</strong>/2<strong>01</strong>1 23/Ro.4/TU/KKP/I/2<strong>01</strong>1 Kemenbudpar 18/<strong>03</strong>/11 12/04/11 156161667000585 25/<strong>01</strong>/2<strong>01</strong>1 KN.372/<strong>01</strong>/<strong>03</strong>/OP.SBA.2<strong>01</strong>1Kantor otoritas pelabuhan III Tj.Perak SBY - DirjendPerhubla - Kemenhub16/<strong>03</strong>/11 1 arpil 2<strong>01</strong>1 1561615670006Hal 4

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>86 25/<strong>01</strong>/2<strong>01</strong>1 B-112/Ses/Bakorkamla/I/2<strong>01</strong>1 Badan Koordinasi Keamanan Laut 23/<strong>03</strong>/11 22/06/11 16164061800<strong>01</strong>87 25/<strong>01</strong>/2<strong>01</strong>1 67/-081 Pemprov DKI Jakarta Kota Adm Jaktim Kec.Cakung Persyaratan tidak lengkap88 25/<strong>01</strong>/2<strong>01</strong>1 800/82/404.3.2/2<strong>01</strong>0 Dinas Kesehatan Pemkab Sidoarjo 16/<strong>03</strong>/11 <strong>01</strong>/04/11 '156161580000789 25/<strong>01</strong>/2<strong>01</strong>1 600/15/PU-Pyk/I/2<strong>01</strong>1 Dinas PU Pemkot Payakumbuh 16/<strong>03</strong>/11 21/07/11 161988193000090 25/<strong>01</strong>/2<strong>01</strong>1 Kd.05.4.1/1/KP.<strong>01</strong>.2/43/2<strong>01</strong>1Kementerian Agama - Kantor Kab Batanghari MuaraBulian<strong>01</strong>/<strong>03</strong>/11 31/<strong>03</strong>/11 1561615<strong>01</strong>000091 25/<strong>01</strong>/2<strong>01</strong>1 602.1/PU-LK/I/2<strong>01</strong>0/06.a Dinas PU Pemprop Riau 16/<strong>03</strong>/11 05/04/11 '156161619000892 25/<strong>01</strong>/2<strong>01</strong>1 242/DPB/TU.330.S1/I/2<strong>01</strong>1 Dirjend Perikanan Budidaya - Kementerian KP 16/<strong>03</strong>/11 31/<strong>03</strong>/11 156161506000593 25/<strong>01</strong>/2<strong>01</strong>1 <strong>01</strong>3/DPSD-SEKRT/I/2<strong>01</strong>1Dinas Pengelolaan Sungai dan Drainase - PemkotBanjarmasin16/<strong>03</strong>/11 31/<strong>03</strong>/11 156161502000994 25/<strong>01</strong>/2<strong>01</strong>1 050/10/441.122/2<strong>01</strong>1 Setda Pemkab. Pamekasan 16/<strong>03</strong>/11 05/04/11 156161624000095 25/<strong>01</strong>/2<strong>01</strong>1 800/00075 Bupati Temanggung <strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '154022755000596 25/<strong>01</strong>/2<strong>01</strong>1 028/042/Umum-2<strong>01</strong>1 Setda Pemprov Sumatera Barat 16/<strong>03</strong>/11 31/<strong>03</strong>/11 156161504000797 25/<strong>01</strong>/2<strong>01</strong>1 B/024/SD/BUH/PL.00.00/1/2<strong>01</strong>1 Badan Pengkajian dan Penerapan Teknologi (BPPT) 21/<strong>03</strong>/11 22/06/11 161640620000698 25/<strong>01</strong>/2<strong>01</strong>1 800/ /PUCK/2<strong>01</strong>1 Dinas PU Bina marga Pemkab. Banyuasin <strong>01</strong>/<strong>03</strong>/11 28/<strong>03</strong>/11 '156124691000799 27/<strong>01</strong>/2<strong>01</strong>1 UM.<strong>01</strong>.<strong>01</strong>-SP.2/78 Sekjend Kementerian PU <strong>01</strong>/<strong>03</strong>/11 22/06/11 1616406080004100 27/<strong>01</strong>/2<strong>01</strong>1 523/37/D.KP/2<strong>01</strong>1Dinas Kelautan dan Perikanan Pemkab Ogan KomeringIlir25/<strong>03</strong>/11 22/06/11 16164060600061<strong>01</strong> 27/<strong>01</strong>/2<strong>01</strong>1 500/100/IV/2<strong>01</strong>1 Setda Pemkab Musi Banyuasin 16/<strong>03</strong>/11 22/06/11 1616406150004102 27/<strong>01</strong>/2<strong>01</strong>1 B-137/R.2/Cp.2/<strong>01</strong>/2<strong>01</strong>1 Kejaksaan Tinggi Sulawesi Tengah - Palu 16/<strong>03</strong>/11 05/04/11 15616162600081<strong>03</strong> 27/<strong>01</strong>/2<strong>01</strong>1 69/UBB/U/I/2<strong>01</strong>1 Universitas Bangka Belitung - Kemendiknas 16/<strong>03</strong>/11 05/04/11 1561616280006104 27/<strong>01</strong>/2<strong>01</strong>1 DL.3<strong>01</strong>/1/1/DJPD/2<strong>01</strong>1Dirjend Perhubungan Darat - KementerianPerhubungan02/08/11 11/10/11 161989145000<strong>01</strong>05 27/<strong>01</strong>/2<strong>01</strong>1 - An Ciptobudoyo 05/<strong>03</strong>/11 05/04/11 1561616180009106 27/<strong>01</strong>/2<strong>01</strong>1 602/0081/DPUK/2<strong>01</strong>1 Dinas PU Pemkab Buleleng 16/<strong>03</strong>/11 05/04/11 1561616200004Hal 5

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>107 27/<strong>01</strong>/2<strong>01</strong>1 PHM.1-UM.<strong>01</strong>.<strong>01</strong>-42 Balitbang HAM - Kementerian Hukum dan HAM RI 31/<strong>03</strong>/11 22/06/11 1616406170002108 27/<strong>01</strong>/2<strong>01</strong>1 020/105/BPSU/II/2<strong>01</strong>1109 27/<strong>01</strong>/2<strong>01</strong>1 77/-081110 27/<strong>01</strong>/2<strong>01</strong>1 658/869/Dislit & TKP111 27/<strong>01</strong>/2<strong>01</strong>1 88/KPI.1/SD/<strong>01</strong>/2<strong>01</strong>1(282/KPI.1/SD/02/2<strong>01</strong>1)Badan Perencanaan Pembangunan Daerah - Pemprop.SumutKota Administrasi Jaktim Kec Cakung Pemprov. DKIJakartaDinas Lingkungan Hidup, Tata Kota dan PedesaanPemkab Hulu Sungai SelatanDirjend Kerjasama Perdagangan InternasionalKementerian Perdagangan16/<strong>03</strong>/11 05/04/11 156161631000<strong>01</strong>6/<strong>03</strong>/11 22/06/11 161640614000516/<strong>03</strong>/11 23/06/11 '154022876000727/04/11 22/06/11 1616406120007112 27/<strong>01</strong>/2<strong>01</strong>1 KP.06.02.Rs/52 Dirjend Penataan Ruang Kementerian PU 23/<strong>03</strong>/11 22/06/11 16164060900<strong>03</strong>113 27/<strong>01</strong>/2<strong>01</strong>1 050/233 Setda Pemkab Kebumen 18/<strong>03</strong>/11 26/04/11 1561618660004114 27/<strong>01</strong>/2<strong>01</strong>1 600/565/DPUK/X/2<strong>01</strong>0 Dinas PU Pemkab Bulungan <strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '1540227560004115 27/<strong>01</strong>/2<strong>01</strong>1 050/16/APP/2<strong>01</strong>1 Setda Pemkab Dompu 16/<strong>03</strong>/11 22/06/11 1616406130006116 28/<strong>01</strong>/2<strong>01</strong>1 B/40/I/2<strong>01</strong>1 Biro Umum Setjend Kementerian pertahanan 16/<strong>03</strong>/11 14/04/11 '1561616720007117 28/<strong>01</strong>/2<strong>01</strong>1 523/021/BI/DKP/2<strong>01</strong>1 Dinas Kelautan dan Perikanan Pemkab Kaur 16/<strong>03</strong>/11 14/04/11 1561616740005118 28/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/151Dinas Perhubungan Komunikasi dan Informatika -Pemprov DIY23/<strong>03</strong>/11 22/06/11 1616406100009119 28/<strong>01</strong>/2<strong>01</strong>1 009/45/Pusdiklat/2<strong>01</strong>1 Pusdiklat Regional Bukit Tinggi Kemendagri 23/<strong>03</strong>/11 14/06/11 1611498590004120 28/<strong>01</strong>/2<strong>01</strong>1 227/5.2-100/I/2<strong>01</strong>1 Badan Pertanahan Nasional (BPN) 16/<strong>03</strong>/11 21/<strong>03</strong>/11 '1540228120009121 28/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/082-Diklat/2<strong>01</strong>1 Badiklat Pemprov Banten 22/<strong>03</strong>/11 <strong>01</strong>/05/11 1580737670008122 28/<strong>01</strong>/2<strong>01</strong>1 440/SEKR/SK/2<strong>01</strong>1/624 Dinas Kesehatan Pemkab Kampar 31/<strong>03</strong>/11 14/06/11 1611498420004'123 31/<strong>01</strong>/2<strong>01</strong>1 136/PPNP/PL.430/I/2<strong>01</strong>1124 31/<strong>01</strong>/2<strong>01</strong>1 B.241/PKTI/I/2<strong>01</strong>1125 31/<strong>01</strong>/2<strong>01</strong>1 KP.06.02-Cq.121/PK-PAM/69126 31/<strong>01</strong>/2<strong>01</strong>1 UM.<strong>01</strong>.11-Sl.13/29Pelabuhan Perikanan Nusantara Pelabuhanratu DirjendPerikanan Tangkap Kementerian KPSatker Pusat Analisis Kerjasama Internasional danAntar Lembaga Kementerian KPSNVT Pengembangan Kinerja PAM Jawa TimurDirjend Cipta Karya Kementerian PUBalai Teknik Air Minum dan Sanitasi Wilayah IISurabaya Dirjend Ciptakarya Kementerian PU23/<strong>03</strong>/11 14/06/11 161149840000621/<strong>03</strong>/11 14/06/11 161149846000022/<strong>03</strong>/11 14/06/11 161149849000724/<strong>03</strong>/11 14/06/11 1611498560007Hal 6

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>127 31/<strong>01</strong>/2<strong>01</strong>1 KU.1<strong>03</strong>.1/15/1/PHB-RBL/2<strong>01</strong>1Satker Bandara Rembele Takengon Kab Bener MeriahDirjend Perhubungan Udara Kementerian Perhubungan24/<strong>03</strong>/11 14/06/11 161149853000<strong>01</strong>28 31/<strong>01</strong>/2<strong>01</strong>1 363/BPSDMKP.<strong>01</strong>/TU.210/I/2<strong>01</strong>1 Badan Pengembangan SDM KP Kementerian KP 23/<strong>03</strong>/11 14/06/11 1611498480008129 31/<strong>01</strong>/2<strong>01</strong>1 B.161/P2HP.0/KP.510/I/2<strong>01</strong>1130 31/<strong>01</strong>/2<strong>01</strong>1 1355/UM.002/PHB-KLM/2<strong>01</strong>0Dirjend Pengolahan dan Pemasaran Hasil PerikananKemennterian KPBandar Udara Kalimaru Dirjend Perhubungan Udara -Kementerian Perhubungan24/<strong>03</strong>/11 14/06/11 16114984300<strong>03</strong><strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '1540228500009131 31/<strong>01</strong>/2<strong>01</strong>1 893/<strong>01</strong>21/V/2<strong>01</strong>1 Setda Pemkab Bangka 24/<strong>03</strong>/11 14/06/11 1611498410005132 31/<strong>01</strong>/2<strong>01</strong>1 HK.605/1/1-BLTL-2<strong>01</strong>1 Balitbang Kementerian Perhubungan 31/<strong>03</strong>/11 14/06/11 16114983600<strong>03</strong>133 31/<strong>01</strong>/2<strong>01</strong>1 S.09/VII/Ren-3/2<strong>01</strong>1Direktorat Perencanaan Kawasan Hutan DirjendPlanologi Kehutanan Kementerian Kehutanan24/<strong>03</strong>/11 14/06/11 16114985000<strong>03</strong>134 31/<strong>01</strong>/2<strong>01</strong>1 Dinkes.441/sekrt/79/I/2<strong>01</strong>1 Dinas Kesehatan Pemkab Belu 24/<strong>03</strong>/11 14/06/11 1611498470009135 31/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/117/PP Setda Pemkab Indramayu 24/<strong>03</strong>/11 14/06/11 16114984500<strong>01</strong>136 31/<strong>01</strong>/2<strong>01</strong>1 39/RSD-BLK/<strong>01</strong>.I/2<strong>01</strong>1137 31/<strong>01</strong>/2<strong>01</strong>1 050/Disnak+Keswan/Bigram/165/<strong>01</strong>-11138 31/<strong>01</strong>/2<strong>01</strong>1 130/079.1RSUD H.Andi Sulthan Daeng Radja PemkabBulukumba24/<strong>03</strong>/11 10/06/11 1611497470000Dinas Peternakan dan Kesehatan Hewan Pemprov Riau 23/<strong>03</strong>/11 10/06/11 1611497540000Biro Kepala Daerah dan Kerjasama Luar NegeriPemprov DKI Jakarta24/<strong>03</strong>/11 10/06/11 1611497500004139 31/<strong>01</strong>/2<strong>01</strong>1 24/SM/KU.02.<strong>01</strong>/<strong>01</strong>/2<strong>01</strong>1 Sekretariat Kementerian Perumahan Rakyat 02/02/11 <strong>03</strong>/<strong>03</strong>/11 '1525666330005140 31/<strong>01</strong>/2<strong>01</strong>1 B.19.<strong>01</strong>/27.0/TU.210/I.2<strong>01</strong>1 Stasiun Karantina Ikan Kelas I El Tari Kementerian KP 24/<strong>03</strong>/11 10/06/11 16114975300<strong>01</strong>141 31/<strong>01</strong>/2<strong>01</strong>1 B/80/I/2<strong>01</strong>1 Kodam V Brawijaya TNI AD 24/<strong>03</strong>/11 10/06/11 1611497480009142 31/<strong>01</strong>/2<strong>01</strong>1 <strong>027</strong>/36/Set-IV/BappedaBadan Perencanaan Pembangunan Daerah PemprovKalimantan Selatan24/<strong>03</strong>/11 10/06/11 16114975100<strong>03</strong>143 31/<strong>01</strong>/2<strong>01</strong>1 1309/H31.11/LL/2<strong>01</strong>1 Universitas Terbuka Kemendiknas 24/<strong>03</strong>/11 10/06/11 161149761000<strong>01</strong>44 31/<strong>01</strong>/2<strong>01</strong>1 650/10/D.1/I/2<strong>01</strong>1 Dinas PU Pemkot Metro 16/<strong>03</strong>/11 05/04/11 1561616410007145 31/<strong>01</strong>/2<strong>01</strong>1 000/323/RSU/2<strong>01</strong>1RSUD Jend.A.Yani Pemkot Metro (sertifikat dikirimke setda pemkot metro)28/<strong>03</strong>/11 14/06/11 1611498440002146 31/<strong>01</strong>/2<strong>01</strong>1 600/14/DPU/I/2<strong>01</strong>1 Dinas PU Pemkab Bangka Tengah 29/<strong>03</strong>/11 10/06/11 1611497640007Hal 7

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>147 31/<strong>01</strong>/2<strong>01</strong>1 S.11/BP2HPIC-1/2<strong>01</strong>1Balai Pemantauan Pemanfaatan Hutan ProduksiWilayah IX Denpasar Dirjend Bina Usaha KehutananKementerian Kehutanan30/<strong>03</strong>/11 14/06/11 1611498510002148 <strong>01</strong>/02/2<strong>01</strong>1 078‐A/H3.13/PPd/2<strong>01</strong>1 LPPKM Universitas Airlangga <strong>01</strong>/<strong>03</strong>/11 <strong>03</strong>/<strong>03</strong>/11 '1525666340004149 <strong>01</strong>/02/2<strong>01</strong>1 007/L.3/TU/2<strong>01</strong>1 Kantor Koordinasi PTS Wil III Kemendiknas 18/<strong>03</strong>/11 22/06/11 16164065400<strong>03</strong>150 <strong>01</strong>/02/2<strong>01</strong>1 600/65-DISPU Dinas PU Pemkot. Banjar 16/<strong>03</strong>/11 21/<strong>03</strong>/11 '1540228080006151 <strong>01</strong>/02/2<strong>01</strong>1 B-020/KP3K/LPSPL.Serang/I/2<strong>01</strong>1Dirjend kelautan, pesisisr dan pulau-pulau kecil, LokaPengelolaan Sumber Daya Pesisir dan Laut SerangBanten - Kementerian KP23/<strong>03</strong>/11 22/06/11 16164064700<strong>03</strong>152 02/02/2<strong>01</strong>1 - an Ari Kuswandari Yushinta 24/<strong>03</strong>/11 22/06/11 1616406500007153 02/02/2<strong>01</strong>1 050/127/434.022/2<strong>01</strong>1 Setda Pemkab Sampang 24/<strong>03</strong>/11 22/06/11 1616406440006154 02/02/2<strong>01</strong>1 B-192/O.4.10/Cp.2/<strong>01</strong>/2<strong>01</strong>1 Kejaksaan Negeri Yogyakarta 21/<strong>03</strong>/11 22/06/11 1616406280008155 02/02/2<strong>01</strong>1 94/STPTU.210/I/2<strong>01</strong>1Sekolah Tinggi Perikanan BPSDM Kelautan danPerikanan Kementerian KP18/<strong>03</strong>/11 26/04/11 1561618620008156 02/02/2<strong>01</strong>1 <strong>01</strong>1/SES/I/2<strong>01</strong>1 Komisi Nasional Hak Asasi Manusia 18/<strong>03</strong>/11 26/04/11 1561618550008157 02/02/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/2<strong>01</strong>1 Dinas PU Pemprov. NTT 27/04/11 22/06/11 1616406310002158 02/02/2<strong>01</strong>1 600/76/Sosnakertrans/2<strong>01</strong>0 Dinas Sosial Nakertrans Pemkab Musi Banyuasin 18/<strong>03</strong>/11 26/04/11 1561618580005159 02/02/2<strong>01</strong>1 045.2/20/Inspt Inspektorat Pemkab Kubu Raya 18/<strong>03</strong>/11 27/04/11 '1540227720002160 02/02/2<strong>01</strong>1 893/72/437.71/2<strong>01</strong>1Badan Perencanaan Pembangunan, Penelitian danPengembangan Daerah Pemkab Gresik<strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '1540228530006161 02/02/2<strong>01</strong>1 <strong>027</strong>/029/437.33/2<strong>01</strong>1 Setda Pemkab Gresik <strong>01</strong>/<strong>03</strong>/11 21/<strong>03</strong>/11 '1540228020002162 02/02/2<strong>01</strong>1 - Sekretariat DPRD Pemprov. Sulawesi Selatan <strong>01</strong>/<strong>03</strong>/11 21/<strong>03</strong>/11 '154022811000<strong>01</strong>63 02/02/2<strong>01</strong>1 W11.U6/178/UM.<strong>03</strong>.06/I/2<strong>01</strong>1 Pengadilan Negeri Klas IA Bale Bandung Sudah lulus ujian164 02/02/2<strong>01</strong>1 PU.600/22/I/2<strong>01</strong>1 Dinas PU Pemkab Lembata 23/<strong>03</strong>/11 24/05/11 161149624000<strong>01</strong>65 02/02/2<strong>01</strong>1 600/046/PU/I/2<strong>01</strong>1 Dinas PU Pemkab Lamandau 23/<strong>03</strong>/11 18/<strong>03</strong>/11 '1540228570002166 02/02/2<strong>01</strong>1 050/165/25/2<strong>01</strong>1 Dinas PU, ESDM Pemkab Magelang 23/<strong>03</strong>/11 22/06/11 1616406480002167 02/02/2<strong>01</strong>1 - Setda Pemkab Bulukumba 23/<strong>03</strong>/11 22/06/11 1616406340009Hal 8

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>168 02/02/2<strong>01</strong>1 050/25/Eko/BappedaBadan Perencanaan Pembangunan Daerah (Bappeda)Pemkab Merangin23/<strong>03</strong>/11 22/06/11 1616406370006169 02/02/2<strong>01</strong>1 893.3/072.29 Badan Kepegawaian Daerah Pemkab Karanganyar 18/<strong>03</strong>/11 22/06/11 1616406450005170 02/02/2<strong>01</strong>1 PD.02.04/BWSS-Sl/120Balai Wilayah Sungai Sumatera - I Dirjend SumberDaya Air Kementerian PU23/<strong>03</strong>/11 14/04/11 1561616770002171 02/02/2<strong>01</strong>1 800/152/2<strong>01</strong>1 RSUD dr. Fauziah Pemkab Bireun 25/<strong>03</strong>/11 22/06/11 1616406420008172 02/02/2<strong>01</strong>1 KP.<strong>01</strong>.02/1/0796/2<strong>01</strong>1RS Kanker Dharmais Dirjend Bina Pelayanan MedikKementerian Kesehatan31/<strong>03</strong>/11 22/06/11 1616406210005173 02/02/2<strong>01</strong>1 259/F31/LK/2<strong>01</strong>1174 02/02/2<strong>01</strong>1 072/55/Balitbangda.Sekr/2<strong>01</strong>1Lembaga Penjaminan Mutu Pendidikan (LPMP) DIYDirjend Peningkatan Mutu Pendidik dan TenagaKependidikan Kementerian Pendidikan NasionalBadan Penelitian dan Pengembangan Daerah PemprovSumatera Selatan<strong>01</strong>/<strong>03</strong>/11 21/<strong>03</strong>/11 '1540228<strong>01</strong>00<strong>03</strong>31/<strong>03</strong>/11 22/06/11 1616406290007175 02/02/2<strong>01</strong>1 136.1/ITJ.0/KP.150/I/2<strong>01</strong>1 Inspektorat Jenderal Kementerian KP 23/<strong>03</strong>/11 22/06/11 16164063200<strong>01</strong>176 02/02/2<strong>01</strong>1 602.1/113/404.3.13/2<strong>01</strong>1 Dinas PU Pengairan Pemkab Sidoarjo 31/<strong>03</strong>/11 22/06/11 1616406350008177 02/02/2<strong>01</strong>1 19/600/PU/I/2<strong>01</strong>1 Dinas PU Pemkot Bitung 25/<strong>03</strong>/11 22/06/11 1616406380005178 02/02/2<strong>01</strong>1 - an Umi Riantiny 31/<strong>03</strong>/11 22/06/11 1616406410009179 02/02/2<strong>01</strong>1 B.223/SJ.1/PL.160/I/2<strong>01</strong>1 Sekjend Kementerian KP 23/<strong>03</strong>/11 22/06/11 161640619000<strong>01</strong>80 02/02/2<strong>01</strong>1 <strong>03</strong>0/0093/2<strong>01</strong>1 Setda Pemkab Batang 02/05/11 22/06/11 16164062500<strong>01</strong>181 02/02/2<strong>01</strong>1 420/078-Set/Disdik/2<strong>01</strong>1 Dinas Pendidikan Pemprov Kalimantan Selatan 23/<strong>03</strong>/11 22/06/11 1616406220004182 02/02/2<strong>01</strong>1 594/408Dinas Perindustrian dan Perdagangan Pemprov JawaTengah23/<strong>03</strong>/11 22/06/11 1616406240002183 02/02/2<strong>01</strong>1 399/H3/KU/2<strong>01</strong>0 Universitas Airlangga 24/10/11 1619894790004 Sertifikat Masih Berlaku184 02/02/2<strong>01</strong>1 425/14/ADP Setda Pemkab Lombok Tengah 02/05/11 22/06/11 161640633000<strong>01</strong>85 02/02/2<strong>01</strong>1 IK<strong>01</strong>06-Aa.0902/70Balai Besar Wilayah Sungai Citanduy Dirjend SumberDaya Air Kementerian PU23/<strong>03</strong>/11 13/04/11 '1561247770006186 02/02/2<strong>01</strong>1 B/229/I/2<strong>01</strong>1/BNN Badan Narkotika Nasional (BNN) RI 23/<strong>03</strong>/11 14/04/11 15616166900<strong>03</strong>187 08/02/2<strong>01</strong>1 <strong>01</strong>/KET/SET-PE/I/2<strong>01</strong>1 Dinas Pertambangan dan Energi Prov. Kepulauan Riau 18/<strong>03</strong>/11 14/04/11 '1540227750009Hal 9

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>188 08/02/2<strong>01</strong>1 045/471/UM.1/2<strong>01</strong>1RSUD Dr. M. Yunus Badan Pelayanan KesehatanMasyarakat Pemprov. Bengkulu18/<strong>03</strong>/11 22/06/11 16164063000<strong>03</strong>189 08/02/2<strong>01</strong>1 893.3/496/2<strong>01</strong>1 Setda Pemkab Purworejo 05/04/11 22/06/11 161640640000<strong>01</strong>90 08/02/2<strong>01</strong>1 297/BPKIMI/BBTPI/I/2<strong>01</strong>1191 08/02/2<strong>01</strong>1 54/-077Balai Besar Teknologi Pencegahan PencemaranIndustri Badan Pengkajian Kebijakan, Iklim dan MutuIndustri Kementerian PerindustrianPerusahaan Daerah Pengelolaan Air Limbah PemprovDKI JKT (PD PAL JAYA)23/<strong>03</strong>/11 22/06/11 16164064900<strong>01</strong>18/<strong>03</strong>/11 22/06/11 1616406580009192 08/02/2<strong>01</strong>1 800/080/I/2<strong>01</strong>1 Dinas Pengairan Pemkab Purworejo Sudah pernah diperpanjang193 08/02/2<strong>01</strong>1 S-1144/WPJ.12/KP.09/2<strong>01</strong>0KPP Madya Malang Kanwil Jatim III DirjendKemenkeu18/<strong>03</strong>/11 22/06/11 1616406550002194 08/02/2<strong>01</strong>1 420/255/PU-BM/2<strong>01</strong>1 Dinas PU Bina Marga Pemprov Sumatera Selatan 23/<strong>03</strong>/11 22/06/11 1616406430007195 08/02/2<strong>01</strong>1 900/H22.13/LK/2<strong>01</strong>1 Universitas Tanjungpura Kemendiknas 23/<strong>03</strong>/11 22/06/11 1616406690005196 08/02/2<strong>01</strong>1 600/17/PUCK.PENG/2<strong>01</strong>1197 08/02/2<strong>01</strong>1 UM.<strong>01</strong>.11-190/46Dinas PU Ciptakarya dan Pengairan Pemkab MusiBanyuasinPusat Pembinaan Penyelenggaraan Konstruksi - BadanPembinaan Kontruksi - Kementerian PU23/<strong>03</strong>/11 10 3 2<strong>01</strong>1 '15616154600<strong>03</strong>18/04/11 18/05/11 1561617580006198 08/02/2<strong>01</strong>1 602.1/PU-LK/II/2<strong>01</strong>1/32 Dinas PU Pemprov. Riau 31/<strong>03</strong>/11 19/05/11 '1561615230002199 08/02/2<strong>01</strong>1 110/073.55200 08/02/2<strong>01</strong>1 893/065Sudin Pendidikan Dasar Pemkot Administrasi JakartaTimurDinas Pengelolaan Keuangan dan Kekayaan DaerahPemkab Sleman18/<strong>03</strong>/11 22/06/11 161640665000923/<strong>03</strong>/11 22/06/11 16164066200022<strong>01</strong> 09/02/2<strong>01</strong>1 600/17-DBT/2<strong>01</strong>1 Dinas Bina Marga dan Tata Ruang Pemprov Banten <strong>01</strong>/04/11 22/06/11 1616406680006202 09/02/2<strong>01</strong>1 050/21/441.122/2<strong>01</strong>1 Setda Pemkab PamekasanSertifikat Masih Berlaku,Surat PermohonanPenggantian SertifikatKeahlian an Eko Santoso2<strong>03</strong> 09/02/2<strong>01</strong>1 <strong>03</strong>97/Bd/I/BBKB/I/2<strong>01</strong>1204 09/02/2<strong>01</strong>1 UM.<strong>01</strong>11/BBWS.SO/818205 09/02/2<strong>01</strong>1 372/Bd/BBIA/II/2<strong>01</strong>1Balai Besar Kerajinan dan Batik - Badan PengkajianKebijakan, Iklim, dan Mutu Industri KementerianPerindustrianBalai Besar Wilayah Sungai Serayu Opak DirjendSumber Daya Air Kementerian PUBalai Besar Industri Agro Badan PengkajianKebijakan, Iklim dan Mutu Industri KementerianPerindustrian05/04/11 22/06/11 161640652000512/05/11 19/08/11 161988488000531/<strong>03</strong>/11 22/06/11 1616406600004Hal 10

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>206 09/02/2<strong>01</strong>1 525/52/BKP.<strong>03</strong>/II/2<strong>01</strong>1 Badan Ketahanan Pangan Pemkab Lahat <strong>01</strong>/04/11 22/06/11 1616406530004207 09/02/2<strong>01</strong>1 522/57/DKH/SETDinas Perkebunan dan Kehutanan Pemkab KapuasHulu<strong>01</strong>/04/11 22/06/11 16164065600<strong>01</strong>208 09/02/2<strong>01</strong>1 W10-A/6<strong>01</strong>/PI.04/II/2<strong>01</strong>1 Pengadilan Tinggi Agama Bandung 21/<strong>03</strong>/11 '1540228330002 Sudah lulus ujian209 09/02/2<strong>01</strong>1 000/Dinkes/2<strong>01</strong>1/142 Dinas Kesehatan Pemkab Rokan Hulu <strong>01</strong>/04/11 '1561615630000 Sertifikat Masih Berlaku210 09/02/2<strong>01</strong>1 050/155/402.021/2<strong>01</strong>1 Bupati Madiun 27/04/11 22/06/11 1616406360007211 09/02/2<strong>01</strong>1 600/06/Bang-I/1/2<strong>01</strong>1 Setda Pemkab Berau 02/05/11 22/06/11 1616406390004212 09/02/2<strong>01</strong>1 B.81/SU-KU/II/2<strong>01</strong>1213 09/02/2<strong>01</strong>1 045.2/176/DIKPORASekretariat Utama Badan Nasional Penempatan danPerlindungan Tenaga Kerja IndonesiaDinas Pendidikan, Pemuda dan Olahraga PemkabPinrang23/<strong>03</strong>/11 22/06/11 1616406660008<strong>01</strong>/04/11 22/06/11 1616406570000214 09/02/2<strong>01</strong>1 B/35/KPP-PA/Roum/I/2<strong>01</strong>1Kementerian Pemberdayaan Perempuan danPerlindungan Anak05/04/11 22/06/11 1616406460004215 09/02/2<strong>01</strong>1 227/K6/KP/2<strong>01</strong>1 Politeknik Negeri Lampung Kemendiknas <strong>01</strong>/04/11 22/06/11 1616406590008216 09/02/2<strong>01</strong>1 050/742 Setda Pemkab Purbalingga 10/06/11 28/06/11 1616409260007217 09/02/2<strong>01</strong>1 028/689 Setda Pemkot Binjai 05/04/11 30/06/11 1616409520002218 09/02/2<strong>01</strong>1 800/71-Kesbangpol/I/2<strong>01</strong>1 Badan Kesatuan Bangsa dan Politik Pemprov Banten 02/05/11 30/06/11 1616409280005219 09/02/2<strong>01</strong>1 800/360/Dalprog Setda Pemkab Karawang 12/05/11 30/06/11 1616409480009220 09/02/2<strong>01</strong>1 <strong>01</strong>/-071.53Kecamatan Duren Sawit Pemkot Administrasi JakartaTimur<strong>01</strong>/04/11 30/06/11 1616409360004221 09/02/2<strong>01</strong>1 009/041/Bandiklatda Badan Pendidikan dan Latihan Daerah Pemprov Jambi 19/04/11 1561618350004 Persyaratan tidak lengkap222 09/02/2<strong>01</strong>1 523.3/<strong>01</strong> Dinas Kelautan dan Perikanan Pemkot Baubau 19/04/11 15616183600<strong>03</strong> Sudah lulus ujian223 09/02/2<strong>01</strong>1 000/144/Disnakertrans Disnakertrans Pemprov Kalimantan Selatan 27/04/11 30/06/11 1616409430004224 09/02/2<strong>01</strong>1 SEK.4.UM.02.<strong>01</strong>.<strong>01</strong> Sekjend Kementerian Hukum dan Hak Asasi Manusia 17/<strong>03</strong>/11 14/04/11 1561616730006225 09/02/2<strong>01</strong>1 <strong>01</strong>9/SES/II/2<strong>01</strong>1 Komisi Nasional Hak Asasi Manusia 19/04/11 30/06/11 1616409250008226 09/02/2<strong>01</strong>1 <strong>027</strong>/0053/II/2<strong>01</strong>1Dinas Kependudukan dan Catatan Sipil PemkabGunungkidul15/04/11 30/06/11 16164093900<strong>01</strong>227 09/02/2<strong>01</strong>1 <strong>027</strong>/00209/TU-KAP/2<strong>01</strong>1 Setda Pemprov Kalimantan Selatan 04/04/11 30/06/11 1616409310009Hal 11

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>228 08/<strong>03</strong>/2<strong>01</strong>1 - an. <strong>No</strong>r Ainun Persyaratan tidak lengkap229 09/02/2<strong>01</strong>1 <strong>027</strong>/4<strong>01</strong>/II/2<strong>01</strong>1 Setda Pemkab Banyumas 14/04/11 28/06/11 16164093700<strong>03</strong>230 09/02/2<strong>01</strong>1 477/141/SET.RENMON Dinas PU Pemprov Kalimantan Barat Persyaratan tidak lengkap231 09/02/2<strong>01</strong>1 B-298/KP3K.0/II/2<strong>01</strong>1Dirjend Kelautan, Pesisir dan Pulau-pulau KecilKementerian KPPersyaratan tidak lengkap232 10/02/2<strong>01</strong>1 020/DK/I/19a/2<strong>01</strong>1 Dinas Kebersihan Pemkot Bitung <strong>01</strong>/<strong>03</strong>/11 18/<strong>03</strong>/11 '15402284900<strong>03</strong>233 10/02/2<strong>01</strong>1 UM.050/D1.30/2<strong>01</strong>1 Dinas Kelautan dan Perikanan Pemprov Maluku Utara 19/04/11 1561618200002 Persyaratan tidak lengkap234 10/02/2<strong>01</strong>1 362/PPSC/Pl.312/I/2<strong>01</strong>1235 10/02/2<strong>01</strong>1 183/PL.140/B.1/2/IIPelabuhan Perikanan Samudera Cilacap DirjendPerikanan Tangkap Kementerian KPSekretariat Dirjend Prasarana & Saran pertanianKementerian Pertanian<strong>01</strong>/<strong>03</strong>/11 21/<strong>03</strong>/11 '154022798000<strong>01</strong>6/<strong>03</strong>/11 15/07/11 1619880660007236 10/02/2<strong>01</strong>1 050/286/Adm.Pemb Setda Pemkab Pemalang 14/04/11 30/06/11 16164094600<strong>01</strong>237 10/02/2<strong>01</strong>1 028/098Dinas Pendapatan, Pengelolaan Keuangan dan AsetDaerah Pemkab Gunungkidul14/04/11 30/06/11 1616409340006238 10/02/2<strong>01</strong>1 148/PRS.1b/I/2<strong>01</strong>1 Dirjend Rehabilitasi Sosial Kementerian Sosial <strong>01</strong>/<strong>03</strong>/11 09/<strong>03</strong>/11 '1540227210008239 10/02/2<strong>01</strong>1 Dis KP.523.5/29/SEK/2<strong>01</strong>1 Dinas Kelautan dan Perikanan Pemkab Flores Timur 05/04/11 30/06/11 1616409270006240 10/02/2<strong>01</strong>1 512/-084.3 Dinas Perindustrian dan Energi Pemprov DKI Jakarta 04/05/11 30/06/11 1616409420005241 10/02/2<strong>01</strong>1 - Dinas Sosial Daerah Pemda Prop Sulawesi Tengah 14/04/11 30/06/11 1616409300000242 11/02/2<strong>01</strong>1 PD.<strong>03</strong>02-sl/100 Pusdiklat Sekjend Kementerian PU 21/<strong>03</strong>/11 30/06/11 1616409450002243 11/02/2<strong>01</strong>1 557/PL.140/E1/2/2<strong>01</strong>1 Dirjend Perkebunan Kementerian Pertanian <strong>01</strong>/04/11 30/06/11 1616409400007244 11/02/2<strong>01</strong>1 600/35/04/2<strong>01</strong>1 Setda Pemkab Lampung Barat 14/04/11 07/07/11 1616410980000245 11/02/2<strong>01</strong>1 020-784 Setda kota Pemkot Binjai 14/04/11 30/06/11 1616409410006246 11/02/2<strong>01</strong>1 <strong>027</strong>/0243/Bina Program/2<strong>01</strong>1 Setda Pemkab Karo 19/04/11 30/06/11 1616409540000247 11/02/2<strong>01</strong>1 600/127/16-LU/2<strong>01</strong>1 Dinas PU Pemkab Lampung Utara 19/04/11 30/06/11 16164095100<strong>03</strong>248 11/02/2<strong>01</strong>1 B-1160/Dep.II/LH/02/2<strong>01</strong>1 Kementerian Lingkungan Hidup (KLH) RI 27/04/11 1580737320002 Persyaratan tidak lengkapHal 12

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>249 14/02/2<strong>01</strong>1 S-049/BPP.04/2<strong>01</strong>1Badiklat Keuangan Cimahi - Badiklat Keuangan-Kemenkeu27/04/11 30/06/11 16164094400<strong>03</strong>250 14/02/2<strong>01</strong>1 440.05/102/Dinkes/KK/2<strong>01</strong>1 Dinas Kesehatan Pemkab Kaur 19/04/11 30/06/11 1616409650006251 14/02/2<strong>01</strong>1 Bdl.<strong>01</strong>/PS.<strong>03</strong>.1/415/2<strong>01</strong>1 Badiklat Keagamaan Medan - Kementerian Agama 27/04/11 30/06/11 16164095300<strong>01</strong>252 14/02/2<strong>01</strong>1 S-16/IAPI-SUMUT.<strong>01</strong>/2<strong>01</strong>1Ikatan Ahli Pengadaan Indonesia (IAPI) DPDSumatera Utara23/<strong>03</strong>/11 15/07/11 1619880470002253 14/02/2<strong>01</strong>1 W29.U3/310/PL.<strong>01</strong>.10/II/2<strong>01</strong>1 Pengadilan Negeri Rangkasbitung 27/04/11 30/06/11 1616409500004254 14/02/2<strong>01</strong>1 611/70/426.109/2<strong>01</strong>1 Dinas PU Pengairan Pemkab Probolinggo 27/04/11 30/06/11 1616409330007255 14/02/2<strong>01</strong>1 800/1<strong>01</strong> Dinas Perhubungan, Kominfo Pemkab Gunungkidul 16/<strong>03</strong>/11 30/06/11 1616409490008256 14/02/2<strong>01</strong>1 445/161/2<strong>01</strong>1 RSUD Pemkab Sukoharjo 27/04/11 30/06/11 161641<strong>01</strong>40008257 14/02/2<strong>01</strong>1 522/51258 14/02/2<strong>01</strong>1 UM.<strong>01</strong>.11-BBWSC/39Dinas Kehutanan dan Perkebunan PemkabGunungkidulBalai Besar Wilayah Sungai Citarum Dirjend SumberDaya Air Kementerian Pekerjaan Umum27/04/11 05/07/11 161641044000923/<strong>03</strong>/11 05/07/11 161641<strong>03</strong>80008259 14/02/2<strong>01</strong>1 <strong>027</strong>/212/Dalprog Setda Pemkot Cilegon 27/04/11 1580737250002 Persyaratan tidak lengkap260 14/02/2<strong>01</strong>1 000/20/II/2<strong>01</strong>1 Setda Pemkab Sukoharjo 27/04/11 05/07/11 161641<strong>03</strong>500<strong>01</strong>261 14/02/2<strong>01</strong>1 893.3/<strong>01</strong>/2<strong>01</strong>1 Dinas PU Pemkab Pekalongan 27/04/11 15/07/11 1619880490000262 14/02/2<strong>01</strong>1 W13-A/425/KS.00/I/2<strong>01</strong>1 Pengadilan Tinggi Agama Surabaya 27/04/11 15/07/11 1619880590007263 14/02/2<strong>01</strong>1 B/578/II/2<strong>01</strong>1/Rosarpras Kepolisian Negara Ri Daerah Istimewa Yogyakarta 02/05/11 15/07/11 1619880700000264 14/02/2<strong>01</strong>1 219/PUK/Bangda/II/2<strong>01</strong>1Dirjend Bina Pembangunan Daerah KementerianDalam Negeri RI<strong>01</strong>/<strong>03</strong>/11 09/<strong>03</strong>/11 '15402271900<strong>03</strong>265 14/02/2<strong>01</strong>1 <strong>027</strong>/195/Sekr Dinas Kehutanan Pemprov Jawa Barat 23/<strong>03</strong>/11 15/07/11 16198804600<strong>03</strong>266 14/02/2<strong>01</strong>1 B-88/Setmilpres/UM/02/2<strong>01</strong>1 Sekretariat Militer Sekretariat Negara 05/05/11 28/07/11 1619882490008267 14/02/2<strong>01</strong>1 0655/H.40.11/LK/2<strong>01</strong>1 Universitas Pendidikan Indonesia 25/<strong>03</strong>/11 30/06/11 161641<strong>01</strong>60006268 16/02/2<strong>01</strong>1 15/Pemb/II/2<strong>01</strong>1 Setda Pemkab Minahasa Utara 25/<strong>03</strong>/11 '1561246560004269 16/02/2<strong>01</strong>1 W3.U2/285/UM/I/2<strong>01</strong>1 Pengadilan Negeri Kls.I.B Bukittinggi 25/<strong>03</strong>/11 30/06/11 1616410220007Sertifikat tidak sesuaidatabaseHal 13

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>270 16/02/2<strong>01</strong>1 AP.600/13/II/2<strong>01</strong>1 Bupati Ende 31/<strong>03</strong>/11 07/07/11 161641<strong>01</strong>70005271 16/02/2<strong>01</strong>1 024.2/119/B.Um-BappBadan Perencanaan Pembangunan Daerah PemprovKalimantan Timur26/05/11 05/07/11 1616410240005272 16/02/2<strong>01</strong>1 420/0741/5.4/II/2<strong>01</strong>1 RSUD Dr.Hi.Abdul Moeloek Pemprov Lampung 25/<strong>03</strong>/11 07/07/11 16164109500<strong>03</strong>273 16/02/2<strong>01</strong>1 <strong>027</strong>/48-PK/2<strong>01</strong>1 Setda Pemkot Cirebon 14/04/11 07/07/11 1616411000004274 16/02/2<strong>01</strong>1 <strong>027</strong>/181Badan Pemberdayaan Masyarakat Perempuan danKeluarga Berencana Pemkab Gunungkidul25/<strong>03</strong>/11 26/04/11 1561618630007275 16/02/2<strong>01</strong>1 910/42/BP-Swl/2<strong>01</strong>1 Setda Kota Pemkot Sawahlunto 14/04/11 07/07/11 1616410920006276 16/02/2<strong>01</strong>1 <strong>027</strong>/102Dinas Perindustrian Perdagangan Koperasi danPertambangan Pemkab Gunungkidul25/<strong>03</strong>/11 05/07/11 1616410250004277 16/02/2<strong>01</strong>1 W6-A2/191/PP.00.4/II/2<strong>01</strong>1 Pengadilan Agama Kelas I B Lahat 25/<strong>03</strong>/11 26/04/11 1561618610009278 16/02/2<strong>01</strong>1 <strong>027</strong>/045 Kantor Pengelolaan Pasar Pemkab Gunungkidul 25/<strong>03</strong>/11 30/06/11 161641<strong>01</strong>30009279 16/02/2<strong>01</strong>1 12.513.623 Badan Pusat Statistik Prov. Sumatera Utara 22/02/11 <strong>03</strong>/<strong>03</strong>/11 '15256663500<strong>03</strong>280 16/02/2<strong>01</strong>1 050/050/424.057/2<strong>01</strong>1 Dinas Bina Marga Pemkab Pasuruan 25/<strong>03</strong>/11 05/07/11 161641<strong>03</strong>20004281 16/02/2<strong>01</strong>1 800/184/414.1<strong>03</strong>/2<strong>01</strong>1 Setda Pemkab Tuban 25/<strong>03</strong>/11 15/07/11 1619880560000282 17/02/2<strong>01</strong>1 S-106/PK.1/2<strong>01</strong>1283 17/02/2<strong>01</strong>1 IK<strong>01</strong>06-Aa.0902/68284 17/02/2<strong>01</strong>1 810/<strong>01</strong>96/C3/Dik/2<strong>01</strong>1Setdirjend Perimbangan Keuangan KementerianKeuanganBalai Besar Wilayah Sungai Citanduy Dirjend SumberDaya Air Kementerian PUDinas Pendidikan Pemuda dan Olahraga PemkotMataram05/04/11 29/06/11 '15616159300<strong>01</strong>31/<strong>03</strong>/11 30/06/11 161641<strong>01</strong>900<strong>03</strong>28/06/11 05/07/11 161641<strong>03</strong>70009285 17/02/2<strong>01</strong>1 890/850/BKD/2<strong>01</strong>1 Setda Pemkab Bangka Tengah 15/06/11 04/07/11 16198805300<strong>03</strong>286 17/02/2<strong>01</strong>1 356/<strong>01</strong>/BBK/DL/II/2<strong>01</strong>1Kepala Balai Besar Keramik Badan pengkajianKebijakan iklim dan Mutu Industri KementerianPerindustrian25/<strong>03</strong>/11 05/07/11 1616410430000287 17/02/2<strong>01</strong>1 <strong>027</strong>/314/Pemb Sekretaris Daerah Pemkab Purwakarta 31/<strong>03</strong>/11 05/07/11 1616410410002288 17/02/2<strong>01</strong>1 <strong>027</strong>/34/Disbun/2<strong>01</strong>1 Kepala Dinas Perkebunan Pemkab Banggai 05/04/11 05/07/11 161641<strong>03</strong>00006289 17/02/2<strong>01</strong>1 800/55/DistambenKepala Dinas Pertambangan dan EnergiPemkab Banggai05/04/11 05/07/11 1616410290000290 17/02/2<strong>01</strong>1 <strong>027</strong>/140/Sekdis Kepala Dinas Pertanian Kabupaten Banggai 05/05/11 05/07/11 161641<strong>03</strong>40002Hal 14

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>291 17/02/2<strong>01</strong>1 190/IPK.1/LT/II/2<strong>01</strong>1 Kepala Pusat Penelitian Geoteknologi LIPI 25/<strong>03</strong>/11 05/07/11 16164104200<strong>01</strong>292 18/02/2<strong>01</strong>1 <strong>027</strong>/312/2<strong>01</strong>1Dinas Perhubungan Komunikasi dan InformatikaPemkab Pekalongan19/04/11 12/08/11 1619883770000293 18/02/2<strong>01</strong>1 060/182/II/e-Proc/ULP/2<strong>01</strong>1 Unit LPSE Pemkot Bontang 19/04/11 05/07/11 16164102600<strong>03</strong>294 18/02/2<strong>01</strong>1 PL.00.<strong>01</strong>.0579Politeknik Kesehatan DenpasarKementerian Kesehatan R.I25/<strong>03</strong>/11 05/07/11 161641<strong>027</strong>0002295 18/02/2<strong>01</strong>1 600/085.13/A2/II/2<strong>01</strong>1 Dinas PU Pemkot Balikpapan Sudah lulus ujian296 18/02/2<strong>01</strong>1 523/378/DKP/2<strong>01</strong>1297 18/02/2<strong>01</strong>1 0990/K8.R/LL/2<strong>01</strong>1298 18/02/2<strong>01</strong>1 444.3/653/DKK/II/2<strong>01</strong>0299 18/02/2<strong>01</strong>1 443/K12/LL/2<strong>01</strong>1300 18/02/2<strong>01</strong>1 B.244/P2MKT-1/II/2<strong>01</strong>1Dinas Kelautan dan PerikananPemerintah Kota BengkuluPoliteknik Negeri BandungDepartemen Pendidikan NasionalDinas Kesehatan Kotapemerintah Kota BalikpapanDirektur Poltek Perkapalan Negeri Surabaya ITSKementerian Pendidikan NasionalDirjen Pembinaan Pengembangan Masyarakat danKawasan Transmigrasi Kementerian Tenaga Kerja danTransmigrasi28/<strong>03</strong>/11 1561247000004 Sudah lulus ujian14/04/11 05/07/11 16164102800<strong>01</strong>14/04/11 05/07/11 16164104000<strong>03</strong>02/05/11 15/07/11 16198805300<strong>03</strong>14/04/11 07/07/11 16164109600023<strong>01</strong> 18/02/2<strong>01</strong>1 171/l1.B<strong>03</strong>/LL/2<strong>01</strong>1 Rektor Institut Teknologi Bandung 25/<strong>03</strong>/11 07/07/11 1616410200009302 <strong>027</strong>/210/Dalbang Bupati Subang 22/06/11 15/07/11 161988063000<strong>03</strong><strong>03</strong> <strong>027</strong>/154/ULP304 18/02/2<strong>01</strong>1 136/076.74/2<strong>01</strong>1305 18/02/2<strong>01</strong>1 KU.04.<strong>03</strong>-Lj.<strong>01</strong>/185Kepala Unit Layanan Pengadaan barang/jasa Pemkab.SubangSuku Dinas Kesehatan Kab. Administrasi Kep. SeribuPemprov DKI JakartaPuslitbang Jalan dan Jembatan Badan Penelitian danPengembangan Kementerian Pekerjaan Umum22/06/11 28/07/11 161988273000525/<strong>03</strong>/11 15/07/11 161988065000822/06/11 15/07/11 1619880670006306 18/02/2<strong>01</strong>1 600/Bm/35.302/2<strong>01</strong>1 Dinas PU Pemprov Riau 25/<strong>03</strong>/11 15/07/11 1619880640009307 18/02/2<strong>01</strong>1 B/371/04/20/2/SET Sekretariat Utama Lembaga Ketahanan Nasional 25/<strong>03</strong>/11 15/07/11 1619880610002308 18/02/2<strong>01</strong>1 600/315/BMP/ME/2<strong>01</strong>1309 21/02/2<strong>01</strong>1 192.1/TU.210/B.1/2/11310 21/02/2<strong>01</strong>1 DL.107/3/1/Sekjen/KKP/2<strong>01</strong>1Dinas PU Bina Marga dan Pengairan Pemkab MuaraEnimSetditjend Prasarana dan Sarana Pertanian KementerianPertanianSekretaris Jenderal Kementerian Kebudayaan danPariwisata25/<strong>03</strong>/11 15/07/11 161988068000531/<strong>03</strong>/11 14/07/11 '15616152200<strong>03</strong>31/<strong>03</strong>/11 15/07/11 16198806200<strong>01</strong>Hal 15

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>311 21/02/2<strong>01</strong>1 KP.<strong>01</strong>.<strong>01</strong>/DPU-BM/125/2<strong>01</strong>1Kepala Dinas Pekerjaan Umum Pemprov KalimantanBarat28/<strong>03</strong>/11 15/07/11 1619880430006312 21/02/2<strong>01</strong>1 <strong>027</strong>/329/Kes/IV/2<strong>01</strong>1 Dinas Kesehatan Pemprov Sumatera Selatan 28/<strong>03</strong>/11 15/07/11 1619880520004313 21/02/2<strong>01</strong>1 68/1.711 Camat Pulogadung Pemkot Adm Jakarta Timur 28/<strong>03</strong>/11 15/07/11 1619880580008314 21/02/2<strong>01</strong>1 800/19/INSP.2<strong>01</strong>1 Inspektur Pemkab Barito Timur 28/<strong>03</strong>/11 15/07/11 1619880540002315 21/02/2<strong>01</strong>1 800/090/II/2<strong>01</strong>1 Kantor Penghubung Daerah Pemprov Sumatera Utara 28/<strong>03</strong>/11 15/07/11 1619880570009316 21/02/2<strong>01</strong>1 142/K12/LL/2<strong>01</strong>1Direktur Poltek Perkapalan Negeri Surabaya ITSKementerian Pendidikan Nasional28/<strong>03</strong>/11 15/07/11 16198806000<strong>03</strong>317 21/02/2<strong>01</strong>1 028/78-Sek Dinas Kebersihan dan Pertamanan Pemkot Tanggerang 16/<strong>03</strong>/11 07/07/11 1616410230006318 21/02/2<strong>01</strong>1 600/DPU/050/II/2<strong>01</strong>1Dinas Pekerjaan Umum Pemkab Bolaang MongondowUtara25/<strong>03</strong>/11 12/07/11 161988<strong>01</strong>30005319 DM.<strong>03</strong>.02.1.229 Direktur Poltekkes Kemenkes Jambi 25/<strong>03</strong>/11 12/07/11 1619880090002320 21/02/2<strong>01</strong>1 <strong>027</strong>/26<strong>01</strong>/Pemb Setda Pemkab Purwakarta 22/06/11 12/07/11 1619880050006321 21/02/2<strong>01</strong>1 900/802/2<strong>01</strong>1Dinas Pendidikan, Kebudayaan, Pemuda dan OlahragaPemkab Bireun25/<strong>03</strong>/11 12/07/11 161988<strong>01</strong>20006322 21/02/2<strong>01</strong>1 523/127/2<strong>01</strong>1Kepala Dinas Kelautan dan perikananPemkab Pidie25/<strong>03</strong>/11 12/07/11 16198800800<strong>03</strong>323 21/02/2<strong>01</strong>1 Kd.02.10/I/Kp.07.6/075/2<strong>01</strong>1Kepala Kantor Kab. Tapanuli SelatanKementerian Agama25/<strong>03</strong>/11 12/07/11 161988<strong>01</strong>10007324 21/02/2<strong>01</strong>1 524/225/2<strong>01</strong>1 Kepala Dinas Peternakan Pemkab Gunungkidul 22/06/11 12/07/11 161988<strong>01</strong>40004325 21/02/2<strong>01</strong>1 Kd.13.5/1/Ks.00/333/2<strong>01</strong>1 Kepala Kantor Kab. Blitar Kementerian Agama 25/<strong>03</strong>/11 12/07/11 1619880<strong>01</strong>000<strong>03</strong>26 21/02/2<strong>01</strong>1 S-261/PW26/1/2<strong>01</strong>1327 21/02/2<strong>01</strong>1 MTs.<strong>01</strong>/<strong>01</strong>.<strong>01</strong>/KP.02.3/27/2<strong>01</strong>1Badan Pengawasan Keuangan dan Pembangunan(BPKP) Perwakilan Prov. PapuaMadrasah Tsanawiyah Negeri Sawang KementerianAgama25/<strong>03</strong>/11 12/07/11 161988004000725/<strong>03</strong>/11 12/07/11 1619880<strong>03</strong>0008328 21/02/2<strong>01</strong>1 600/22/PUCK/2<strong>01</strong>0 Dinas PU Cipta Karya Pemkab Banyuasin 14/04/11 25/07/11 1619882020007329 21/02/2<strong>01</strong>1 890/<strong>03</strong>/PU BM/2<strong>01</strong>1 Dinas PU Bina marga pemkab banyuasin 05/05/11 12/07/11 1619880060005330 21/02/2<strong>01</strong>1 37/600/PUK/II/2<strong>01</strong>1 Dinas PU Pemkab Tana Toraja 22/06/11 07/07/11 161641<strong>01</strong>50007331 21/02/2<strong>01</strong>1 445/231/2<strong>01</strong>1 RSUD Pemkot Semarang 19/04/11 1561618<strong>03</strong>0005 Persyaratan tidak lengkap332 21/02/2<strong>01</strong>1 020-891 Setda Kota Pemkot Binjai 18/04/11 07/07/11 161641<strong>01</strong>80004Hal 16

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>333 21/02/2<strong>01</strong>1 B/440/II/2<strong>01</strong>1 Pusat Penerbangan MABES AD 14/04/11 12/07/11 161988<strong>01</strong>500<strong>03</strong>334 21/02/2<strong>01</strong>1 PD <strong>03</strong>.02.SU/70 Setjend Kementerian PU Persyaratan tidak lengkap335 21/02/2<strong>01</strong>1 50/BAP II/2<strong>01</strong>1 Setda Pemprov Sumatera Utara 14/04/11 07/07/11 161641<strong>01</strong>2000<strong>03</strong>36 21/02/2<strong>01</strong>1 32/DKP.523/11.10Dinas Kelautan dan Perikanan Pemkab KepulauanAnambas14/04/11 02/08/11 1619882700008337 21/02/2<strong>01</strong>1 -Balai Bendungan Dirjend Sumber Daya AirKementerian PU28/<strong>03</strong>/11 12/07/11 1619880020009338 22/02/2<strong>01</strong>1 B/83/II/2<strong>01</strong>1 Biro Umum Setjend Kemhan 19/04/11 07/07/11 1616410210008339 22/02/2<strong>01</strong>1 530/202/2<strong>01</strong>1Dinas Perindustrian Perdagangan dan Koperasi PemkabPidie18/04/11 07/07/11 1616410610006340 22/02/2<strong>01</strong>1 233/PL.210/J1/11Badan Penyuluhan dan Pengembangan Sumber DayaManusia Kementerian Pertanian18/04/11 07/07/11 1616410560004341 22/02/2<strong>01</strong>1 523/173/DKP/II/2<strong>01</strong>1 Dinas Kelautan dan Perikanan Pemprov Sulawesi Barat 18/04/11 07/07/11 16164105900<strong>01</strong>342 22/02/2<strong>01</strong>1 12<strong>03</strong>/F15.22/KP/2<strong>01</strong>1Pusat Pengembangan dan Pemberdayaan Pendidik danTenaga Kependidikan Bidang Otomotif danElektronika Dirjend PMPTK Kemendiknas14/04/11 07/07/11 1616410620005343 22/02/2<strong>01</strong>1 <strong>027</strong>/118/KD-Program Dinas Perhubungan Pemprov Jawa Barat 14/04/11 12/07/11 1619880200005344 22/02/2<strong>01</strong>1 178/11-100.2/II/2<strong>01</strong>1 Badan Pertanahan Nasional Kanwil Prov. Aceh 14/04/11 12/07/11 161988<strong>01</strong>00008345 22/02/2<strong>01</strong>1 094/208/DPU/Pera/2<strong>01</strong>1 Dinas PU dan Perumahan Rakyat Pemkab Sarolangun 21/<strong>03</strong>/11 12/07/11 1619880070004346 22/02/2<strong>01</strong>1 578/-084.3 Dinas Perindustrian dan Energi Pemprov DKI Jakarta347 22/02/2<strong>01</strong>1 1617/-084.3 Dinas Perindustrian dan Energi Pemprov DKI Jakarta348 22/02/2<strong>01</strong>1 <strong>027</strong>/62 Setda Pemkab Pekalongan19/04/1115/07/11 16198805500<strong>01</strong>349 22/02/2<strong>01</strong>1 <strong>027</strong>/24 Setda Pemkab Pekalongan350 22/02/2<strong>01</strong>1 <strong>027</strong>/127 Setda Pemkab Pekalongan351 22/02/2<strong>01</strong>1 <strong>027</strong>/144 Setda Pemkab Pekalongan14/04/11 15/07/111619880730007352 22/02/2<strong>01</strong>1 <strong>027</strong>/39 Satuan Polisi Pamong Praja Pemkab Pekalongan 18/04/11 12/07/11 1619880230002353 22/02/2<strong>01</strong>1 600/346 Pemkab Kulon Progo 16/<strong>03</strong>/11 12/07/11 161988<strong>03</strong>00002354 22/02/2<strong>01</strong>1 1252/PII/Dir.PPA/2<strong>01</strong>1 Universitas Gajah Mada 02/05/11 30/06/11 1616409470000Hal 17

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>355 23/02/2<strong>01</strong>1 UM.<strong>01</strong>.11-Sl.04/48356 23/02/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/1/1113/II/2<strong>01</strong>1Badiklat Wilayah IV Surabaya Pusdiklat SetjendKementerian PUPoliteknik Kesehatan Kemenkes Malang KementerianKesehatan18/04/11 1561617550009 Persyaratan tidak lengkap27/04/11 25/07/11 1619881990004357 23/02/2<strong>01</strong>1 810/065 Kecamatan Girisubo Pemkab Gunungkidul 18/04/11 1561617640007 Sertifikat Masih Berlaku358 23/02/2<strong>01</strong>1 055/37/416-022/2<strong>01</strong>1 Setda Pemkab Mojokerto 18/04/11 1561617930009 Sertifikat Masih Berlaku359 23/02/2<strong>01</strong>1 - Dinas Kesehatan Pemkab Mojokerto 19/04/11 1561618080000 Sertifikat Masih Berlaku360 23/02/2<strong>01</strong>1 83/893.3/II/2<strong>01</strong>1Panitia Pengadaan Barang dan Jasa Dinas PU PemkabKutai Kartanegara15/04/11 15616172000<strong>03</strong> Sertifikat Masih Berlaku361 23/02/2<strong>01</strong>1 600/145/DPUK./I/2<strong>01</strong>1 Dinas PU Pemkab Agam 27/04/11 25/07/11 1619881960007362 23/02/2<strong>01</strong>1 900/0458/III.10.I/II/2<strong>01</strong>1 Dinas Kesehatan Pemprop Lampung 14/04/11 26/07/11 1561617190007363 23/02/2<strong>01</strong>1 TU.00.<strong>01</strong>/I/2/<strong>01</strong>83/2<strong>01</strong>1364 23/02/2<strong>01</strong>1 04/BRIB/II/2<strong>01</strong>1Politeknik Kesehatan Kemenkes YogyakartaKementerian KesehatanUPTD Balai Pengawasan dan Sertifikasi BenihTanaman Pangan dan Holtikultura Dinas PertanianTanaman Pangan Pemerintah Aceh14/04/11 25/07/11 161988212000427/04/11 1580737420009 Persyaratan tidak lengkap365 23/02/2<strong>01</strong>1 594/H30/KP/2<strong>01</strong>1 Universitas Bengkulu Kemendiknas 14/04/11 25/07/11 161988209000<strong>03</strong>66 23/02/2<strong>01</strong>1 900/728/35/2<strong>01</strong>1 Setda Pemkab Tanggamus <strong>01</strong>/04/11 21/07/11 1619881710008367 23/02/2<strong>01</strong>1 900/60.A/19-LU/VI/2<strong>01</strong>1 Sekretariat Kabupaten Pemkab Lampung Utara 14/04/11 25/07/11 1619882<strong>01</strong>0008368 23/02/2<strong>01</strong>1 800/298/III.15.SET/2<strong>01</strong>1 Dinas Kelautan dan Perikanan Pemprov.Lampung 15/04/11 21/07/11 1619881590006369 23/02/2<strong>01</strong>1 <strong>027</strong>/0434/Adp.Pemb Setda Pemkab Sumedang 15/04/11 25/07/11 1619881980005370 23/02/2<strong>01</strong>1 <strong>027</strong>/0<strong>01</strong>37Dinas PU, Perumahan dan ESDM (DPUP - ESDM)Pemprov DIY14/04/11 02/08/11 161988261000<strong>03</strong>71 23/02/2<strong>01</strong>1 0781/SU.3/KS/II/2<strong>01</strong>1 Lembaga Ilmu Pengetahuan Indonesia (LIPI) 14/04/11 21/07/11 161988179000<strong>03</strong>72 23/02/2<strong>01</strong>1 -373 23/02/2<strong>01</strong>1 028/135/2<strong>01</strong>1374 23/02/2<strong>01</strong>1 TU.221.183.02.2<strong>01</strong>1an Muhammad Amin staff pusat Penjaminan MutuPendidikan STAIN CurupDinas Pertanian Perkebunan dan Kehutanan PemkabMajeneBadan Ketahanan Pangan dan Pelaksana PenyuluhanPertanian, Perikanan dan Kehutanan Pemkab Majene15/04/11 25/07/11 16198821500<strong>01</strong>18/04/11 21/07/11 161988189000714/04/11 21/07/11 16198818300<strong>03</strong>375 23/02/2<strong>01</strong>1 900/474/419.80/2<strong>01</strong>1 RSUD Gambiran Pemkot Kediri 21/<strong>03</strong>/11 21/07/11 16198819000<strong>03</strong>Hal 18

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>376 24/02/2<strong>01</strong>1 199/BPSPL.02/II/2<strong>01</strong>1Dirjend Kelautan, Pesisir, dan Pulau-Pulau Kecil BalaiPengelolaan Sumberdaya Pesisir dan Laut (BPSPL)Bali Kementerian KP14/04/11 21/07/11 1619881800006377 24/02/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>01</strong>-15/393 Inspektorat Jenderal Kementerian Pekerjaan Umum 05/05/11 22/06/11 1580739100008378 24/02/2<strong>01</strong>1 <strong>027</strong>/47/PB Setda Pemkab Sambas 14/04/11 25/07/11 1619882100006379 24/02/2<strong>01</strong>1 <strong>027</strong>/DKIPDE-UP/II/62Dinas Komunikasi Informatika dan Pengolahan DataElektronik Pemprov Riau18/04/11 21/07/11 1619881770002380 24/02/2<strong>01</strong>1 PL.02.06-KS/172 Badan Pembinaan Konstruksi Kementerian PU 18/04/11 21/07/11 161988162000<strong>03</strong>81 24/02/2<strong>01</strong>1 Um.<strong>01</strong>.11-Rs/183 Dirjend Penataan Ruang Kementerian PU Persyaratan tidak lengkap382 24/02/2<strong>01</strong>1 523.<strong>027</strong>/84/TU.2/II/2<strong>01</strong>1Dinas Kelautan dan Perikanan Pemprov KalimantanBarat19/04/11 1561618150000 Persyaratan tidak lengkap383 24/02/2<strong>01</strong>1 028/386/BKD Badan Kepegawaian Daerah Pemkab Kendal 18/04/11 25/07/11 1619882070002384 24/02/2<strong>01</strong>1 17/BPPT/B2TE/SD/02/2<strong>01</strong>1 Balai Besar Teknologi Energi 14/04/11 21/07/11 1619881820004385 24/02/2<strong>01</strong>1 204/800/II/2<strong>01</strong>1386 24/02/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/VIII.28/243/2<strong>01</strong>1SMPN 34 Semarang Dinas Pendidikan PemkotSemarangKantor Kesehatan Pelabuhan Kelas III Jambi DirjendPengendalian Penyakit dan Penyehatan LingkunganKementerian Kesehatan19/04/11 25/07/11 16198820600<strong>03</strong>19/04/11 25/07/11 16198821300<strong>03</strong>387 24/02/2<strong>01</strong>1 (W.10-A22/455/OT.1/II/2<strong>01</strong>1)an. Ita Sasmita (Ketua Pengadilan Agama Depok Kls 1B)18/04/11 1561617540000 Sudah lulus ujian388 24/02/2<strong>01</strong>1 513/H5.2.1.1/SDM/2<strong>01</strong>1Fakultas Kedokteran Universitas Sumatera UtaraKemendiknas19/04/11 25/07/11 1619882110005389 24/02/2<strong>01</strong>1 B-23.<strong>03</strong>/BBATJ/PL.440/II/2<strong>01</strong>1Balai Budidaya Air Tawar Jambi - Dirjend PerikananBudidaya Kementerian KP18/04/11 25/07/11 1619882240009390 24/02/2<strong>01</strong>1 841/821/Dikpora/2<strong>01</strong>1Dinas Pendidikan Pemuda dan Olahraga PemkabSumbawa Barat05/04/11 25/07/11 16198820800<strong>01</strong>391 24/02/2<strong>01</strong>1 <strong>01</strong>0/setda/42.b/1/2<strong>01</strong>1 Setda Pemkab Gorontalo Utara 18/04/11 25/07/11 1619882210002392 24/02/2<strong>01</strong>1 600/PU/24.a/1/2<strong>01</strong>1 Dinas Pekerjaan Umum Pemkab Gorontalo Utara 18/04/11 25/07/11 1619882180008393 24/02/2<strong>01</strong>1 393/H4.32/LK.33/2<strong>01</strong>1394 24/02/2<strong>01</strong>1 PL.02<strong>01</strong>-Bt.44<strong>03</strong>72/36a395 28/02/2<strong>01</strong>1 -Fakultas Farmasi Universitas HasanuddinKemendiknasDirektorat Bina Teknik Dirjend Bina MargaKementerian PUan. M. Syaefuddin Dit Produksi Ditjen PerikananBudidaya Kementerian Kelautan dan Perikanan19/04/11 15616180500<strong>03</strong> Sudah lulus ujianPersyaratan tidak lengkap20/05/11 16114950800<strong>03</strong> Persyaratan tidak lengkap396 28/02/2<strong>01</strong>1 890/050/435.102/2008 Dinas Kesehatan Pemkab Sumenep 18/<strong>03</strong>/11 14/04/11 15616167600<strong>03</strong>Hal 19

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>397 28/02/2<strong>01</strong>1 584/1.851.202.1 SMPN 46 Dinas Pendidikan Pemprov DKI Jakarta 19/04/11 21/07/11 1619881560009398 28/02/2<strong>01</strong>1 028/0285 Setda Pemkab Gunung Kidul 19/04/11 25/07/11 1619882050004399 28/02/2<strong>01</strong>1 28/KPU-Kab-<strong>01</strong>33299599/P.KADA/II/2<strong>01</strong>1Komisi Pemilihan Umum Kab Kulon Progo 19/04/11 25/07/11 1619882040005400 28/02/2<strong>01</strong>1 B/264/II/2<strong>01</strong>1 Direktorat Perhubungan MAbesAD 27/04/11 21/07/11 16198816800044<strong>01</strong> 28/02/2<strong>01</strong>1 LOG.4/840/II/2<strong>01</strong>1 Kepolisian Negara RI Daerah NTB 19/04/11 1561618040004 Persyaratan tidak lengkap402 28/02/2<strong>01</strong>1 <strong>027</strong>/105/437.41/2<strong>01</strong>1 Sekretariat DPRD Pemkab Gresik 18/<strong>03</strong>/11 21/<strong>03</strong>/11 '15402280700074<strong>03</strong> 28/02/2<strong>01</strong>1 602.1/239/416-108.L/2<strong>01</strong>1 Dinas PU Pengairan Pemkab Mojokerto 18/04/11 21/07/11 1619881720007404 28/02/2<strong>01</strong>1 In.<strong>03</strong>/3.1/Ks.<strong>01</strong>.6/129/2<strong>01</strong>1 IAIN Raden Fatah Kementerian Agama 31/<strong>03</strong>/11 '15616151700<strong>01</strong> Sudah lulus ujian405 28/02/2<strong>01</strong>1 050/<strong>01</strong>.17/Bappeda/II/2<strong>01</strong>1 Setda Pemkab Toraja Utara 19/04/11 21/07/11 1619881750004406 28/02/2<strong>01</strong>1 -an Yerinaldi ( STAIN Sjech M. Djamil DjambekBukittinggi)18/04/11 21/07/11 16198816900<strong>03</strong>407 28/02/2<strong>01</strong>1 800/341/2<strong>01</strong>1 Dinas PU Pemkab Gunung Kidul 23/<strong>03</strong>/11 22/06/11 1616406260000408 28/02/2<strong>01</strong>1 050/125/dishub-sek/2<strong>01</strong>1 Dinas Perhubungan Pemprov Kalimantan Timur 19/04/11 21/07/11 1619881740005409 28/02/2<strong>01</strong>1 <strong>027</strong>/307/408.16/2<strong>01</strong>1 Setda Pemkab Pacitan 27/04/11 02/08/11 1619882670004410 28/02/2<strong>01</strong>1 - an. Wahyudiono 19/04/11 25/05/11 1561618370002411 28/02/2<strong>01</strong>1 800/0252/405.11/2<strong>01</strong>1 Dinas Perhubungan Pemkab Ponorogo 19/04/11 25/07/11 1619882250008412 28/02/2<strong>01</strong>1 <strong>027</strong>/0427/BK/P2MKT Disnakertrans Pemda Prop. Sulawesi Tengah 19/04/11 21/07/11 1619881880008413 28/02/2<strong>01</strong>1 W13-U3/249/UM.10/II/2<strong>01</strong>1 Pengadilan Negeri Wates 05/05/11 <strong>01</strong>/08/11 15807388700<strong>01</strong>414 28/02/2<strong>01</strong>1 <strong>027</strong>/496/BPAP Setda Pemkab Cianjur 19/04/11 02/08/11 1619882870008415 28/02/2<strong>01</strong>1 893.3/14/2<strong>01</strong>1 Kantor Lingkungan Hidup Pemkab Pekalongan 27/04/11 15807374000<strong>01</strong> Persyaratan tidak lengkap416 28/02/2<strong>01</strong>1 045.2/134/Umum.A Setda Pemkot Singkawang 14/04/11 28/07/11 1619882720006417 28/02/2<strong>01</strong>1 <strong>027</strong>/0661/Ro.UHP Setda Pemprov DIY 15/04/11 28/07/11 1619882520002418 28/02/2<strong>01</strong>1 118/-077.22 Kecamatan Ciracas Pemkot Administrasi Jakarta Timur 19/<strong>03</strong>/11 28/07/11 1619882690002419 28/02/2<strong>01</strong>1 007/246/upeg Dinas Perkebunan Pemprop Sulawesi Selatan 18/<strong>03</strong>/11 28/07/11 1619882660005Hal 20

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>420 28/02/2<strong>01</strong>1 900/359/02.3/11 Sekretariat Kota Pemkot Bandar Lampung 27/04/11 02/08/11 1619882640007421 28/02/2<strong>01</strong>1 008/<strong>03</strong>/DBT/BPOK/II/2<strong>01</strong>1 Dinas Bina Marga dan Tata Ruang Pemprov Banten 28/04/11 28/07/11 1619882630008422 28/02/2<strong>01</strong>1 893/56/Diklat/VI/2006 Badiklat Pemprov BAnten Persyaratan tidak lengkap423 22/02/2<strong>01</strong>1 -424 <strong>03</strong>/<strong>03</strong>/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>03</strong>/PBL-JTG/2<strong>01</strong>an. Sri Handayani & Agung Hariyadi (DinasPerindustrian dan Perdagangan Jateng)SNVT Penataan bangunan dan Lingkungan JawaTengah Dirjend Cipta Karya Kementerian PU02/05/11 28/07/11 16198826000<strong>01</strong>Persyaratan tidak lengkap425 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/0627/V/2<strong>01</strong>1 Setda Pemprov Sumatera Selatan Persyaratan tidak lengkap426 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 -an Isnaini Badan Pemberdayaan MasyarakatPemperdayaan Perempuan dan Keluarga BerencanaPemprov Jambi22/06/11 28/07/11 1619882710007427 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 243/KT.304/H/2<strong>01</strong>1 BKKBN 02/05/11 28/07/11 16198826800<strong>03</strong>428 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 W22.PAS.1.UM.<strong>01</strong>.<strong>01</strong>-224Lembaga Pemasyarakatan Narkotika Klas IIYogyakarta Kemenhukham Kanwil DIY05/05/11 28/07/11 1619882650006429 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 522/87/DISHUT-2<strong>01</strong>1 Dinas Kehutanan Pemkab Sijunjung 12/05/11 28/07/11 1619882620009430 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 S-<strong>01</strong>/PJ.<strong>01</strong>41/2<strong>01</strong>1 Setditjend Pajak Kementerian Keuangan Persyaratan tidak lengkap431 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 098/DAGLU.5-TU/II/2<strong>01</strong>1 Dirjend Perdagangan Luar Negeri Persyaratan tidak lengkap432 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 893.3/513/AKP.Aset Setda Pemprov Bali 02/05/11 02/08/11 16198828400<strong>01</strong>433 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 602/160A/405.12/2<strong>01</strong>1 Setda Pemkab Ponorogo <strong>03</strong>/05/11 28/07/11 16198824400<strong>03</strong>434 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 050/255/402.021/2<strong>01</strong>1 Bupati Madiun Persyaratan tidak lengkap435 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 521.11.10/72/BPTPH/2<strong>01</strong>1Balai Perlindungan Tanaman Pangan dan HortikulturaSumatera Barat Dinas Pertanian Tanaman PanganPemprov Sumatera Barat22/06/11 28/07/11 16198826800<strong>03</strong>436 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 600/71/DPU/II/2<strong>01</strong>1 Dinas PU Pemkab Samosir Persyaratan tidak lengkap437 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 556/140/Disparbudpora/2<strong>01</strong>1438 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 800/0220/BAPPEDA/II/2<strong>01</strong>1439 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 W2.E12.DL.<strong>01</strong>.<strong>01</strong>-392-2<strong>01</strong>1Dinas Periwisata Kebudayaan Pemuda dan OlahragaPemkot GunungsitoliBadan Perencanaan Pembangunan Daerah PemkabBatubaraKementerian Hukum dan HAM Kanwil SumateraUtaraSertifikat Masih BerlakuSudah lulus ujianPersyaratan tidak lengkap440 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 800/525 Dinas Bina Marga Pemkot Medan Sudah lulus ujianHal 21

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>441 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 990/006/2<strong>01</strong>1Dinas PU Pemkot Lhokseumawe (dinas kelautan,perikanan dan pertanian) Pemkot Lhokseumawe06/06/11 28/07/11 16198824600<strong>01</strong>442 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 524/184/2<strong>01</strong>1 Dinas Peternakan Pemkab Aceh Besar Sertifikat Masih Berlaku443 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 b02.1/244/DP2KP/2<strong>01</strong>1Dinas Pertanian, Peternakan, Kelautan dan PerikananPemkab Nias UtaraSertifikat Masih Berlaku444 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 800/334/2<strong>01</strong>1 Dinas Kesehatan Pemkab Aceh Timur 06/06/11 28/07/11 16198824600<strong>01</strong>445 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 - BAPPEDA Pemkab Aceh Timur Sertifikat Masih Berlaku446 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 800/186/2<strong>01</strong>1 Dinas Kelautan dan Perikanan Pemkab Aceh Timur Sertifikat Masih Berlaku447 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 602.1/BMP-SET/244 Dinas Bina Marga Dan Pengairan Pemkab Kampar Sertifikat Masih Berlaku448 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>1 107/SJ-IND.3/2/2<strong>01</strong>1 Setjend Kementerian Perindustrian 02/05/11 06/07/11 1616410750009449 02/<strong>03</strong>/2<strong>01</strong>1 Um.<strong>01</strong>.<strong>01</strong>.SR-PU/06Kepala Bagian Perencanaan Umum SekretariatJenderal Kementerian Pekerjaan Umum02/05/11 21/07/11 1619881700009450 02/<strong>03</strong>/2<strong>01</strong>1 2350/LKI-54/2<strong>01</strong>1 Lembaga Kajian Indonesia - Pekanbaru 06/06/11 22/07/11 1619880740006451 02/<strong>03</strong>/2<strong>01</strong>1 05/453/Sekr.1/22/2<strong>01</strong>1 Dinas Pendidikan Pemprov Sumatera Utara Persyaratan tidak lengkap452 02/<strong>03</strong>/2<strong>01</strong>1 PL.<strong>03</strong>.<strong>01</strong>/0639/2<strong>01</strong>1 Politeknik Kesehatan Kemkes Padang Kemenkes 22/06/11 22/07/11 1619880690004453 02/<strong>03</strong>/2<strong>01</strong>1 1537/H3.5/LK/2<strong>01</strong>1 Universitas Airlangga 22/06/11 21/07/11 16198817800<strong>01</strong>454 02/<strong>03</strong>/2<strong>01</strong>1 99/PPNS.<strong>03</strong>/PL.430/II/2<strong>01</strong>1Pelabuhan Perikanan Nusantara Sibolga Dir jendPerikanan Tangkap Kementerian KPPersyaratan tidak lengkap455 02/<strong>03</strong>/2<strong>01</strong>1 050/089.A/25 Dinas Cipta Karya dan Tata Ruang Pemkab Cilacap 21/<strong>03</strong>/11 21/07/11 1619881840002456 02/<strong>03</strong>/2<strong>01</strong>1 650/81/DTRK-B Dinas Tata Ruang Kota Pemkab Bontang 25/06/11 15/07/11 1619880740006457 02/<strong>03</strong>/2<strong>01</strong>1 024.2/2<strong>01</strong>0 Balitbang Pemprov. Jawa Tengah 26/06/11 21/07/11 1619881810005458 02/<strong>03</strong>/2<strong>01</strong>1 0736/K4.LL/2<strong>01</strong>1 Politeknik Pertanian Negeri Payakumbuh Kemendiknas Sertifikat Masih Berlaku459 02/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/000415/VIII Walikota Palembang 14/04/11 09/08/11 1619883180007460 02/<strong>03</strong>/2<strong>01</strong>1 Um.<strong>01</strong>.<strong>03</strong>-Bs/134 Dirjend Bina Marga Kementerian PU 14/06/11 24/08/11 1619884980002461 02/<strong>03</strong>/2<strong>01</strong>1 UK.112/2/4/DNG.TPK.11Distrik Navigasi Kelas I Tanjung Priok DirjendPerhubungan Laut Kementerian Perhubungan02/05/11 21/07/11 1619881530002Hal 22

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>483 04/<strong>03</strong>/2<strong>01</strong>1 600/108/PU-Pyk/III-2<strong>01</strong>1 Dinas Pekerjaan Umum Pemkot Payakumbuh Persyaratan tidak lengkap484 04/<strong>03</strong>/2<strong>01</strong>1 800-1413 Setda Pemkot Binjai 28/06/11 12/07/11 16198802400<strong>01</strong>485 04/<strong>03</strong>/2<strong>01</strong>1 S-78/WPJ.22/KP.07/2<strong>01</strong>1KPP Madya Bekasi Dirjend Pajak Kanwil DJP JawaBarat II Kementerian Keuangan28/06/11 21/07/11 16198817600<strong>03</strong>486 04/<strong>03</strong>/2<strong>01</strong>1 445/226/RSD/2<strong>01</strong>1 RSD KH. Daud Arif Pemkab Tanjung Jabung Barat 28/06/11 12/07/11 1619880210004487 04/<strong>03</strong>/2<strong>01</strong>1 Kd.10.15/1/HK.00.7/478/2<strong>01</strong>1 Kementerian Agama Kantor Kabupaten Karawang 28/06/11 12/07/11 161988<strong>01</strong>700<strong>01</strong>488 04/<strong>03</strong>/2<strong>01</strong>1 470/042Dinas Kependudukan dan Pencatatan Sipil PemkabBireun28/06/11 12/07/11 1619880260009489 04/<strong>03</strong>/2<strong>01</strong>1 050/576/2<strong>01</strong>1 RSUD Dokter Soesilo Pemkab Tegal 28/06/11 25/07/11 1619881940009490 04/<strong>03</strong>/2<strong>01</strong>1 B-41/C.3/Cum.3/02/2<strong>01</strong>1 Kejaksaan Agung RI 28/06/11 21/07/11 1619881730006491 04/<strong>03</strong>/2<strong>01</strong>1 - Dinas Pekerjaan Umum Pemkab Seluma 28/06/11 21/07/11 1619880290006492 04/<strong>03</strong>/2<strong>01</strong>1 890/08/UPTD-ULP/2<strong>01</strong>1493 07/<strong>03</strong>/2<strong>01</strong>1 S-1099/WPJ.07/2<strong>01</strong>1UPTD Layanan Pengadaan Barang/Jasa Dinas PUPemkot Banda AcehDirjend Pajak Kanwil DJP Jakarta KhususKementerian Keuangan RI27/04/11 21/07/11 161988191000228/06/11 22/07/11 1619882140002494 07/<strong>03</strong>/2<strong>01</strong>1 800/II.2.009/DF/III/BKD/2<strong>01</strong>1 BKD Pemkab Kutai Kartanegara Persyaratan tidak lengkap495 07/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/57/05/UK/2<strong>01</strong>1 Setda Kabupaten Pemkab Lampung Timur 27/04/11 09/08/11 1619883150000496 07/<strong>03</strong>/2<strong>01</strong>1 S-754/PJ.<strong>01</strong>/UP.51/2<strong>01</strong>1 Setditjen Pajak Kementerian Keuangan 27/04/11 09/08/11 1619883270005497 07/<strong>03</strong>/2<strong>01</strong>1 139/DPU/III/2<strong>01</strong>1 Dinas Pekerjaan Umum Pemkab Kutai Kartanegara 27/04/11 09/08/11 16198830700<strong>01</strong>498 07/<strong>03</strong>/2<strong>01</strong>1 Dj.II.2/6/KP.00.3/271/2<strong>01</strong>1Direktorat Jenderal Bimbingan Masyarakat IslamKementerian Agama04/05/11 09/08/11 1619883240008499 07/<strong>03</strong>/2<strong>01</strong>1 B.163A/SJ-KU/II/2<strong>01</strong>1 Setjend Kemenakertarns RI 27/04/11 09/08/11 1619883110004500 07/<strong>03</strong>/2<strong>01</strong>1 <strong>01</strong>81.a/H9.3.2/PL/2<strong>01</strong>1 Universitas Sriwijaya Kemendiknas 27/04/11 09/08/11 16198831200<strong>03</strong>5<strong>01</strong> 07/<strong>03</strong>/2<strong>01</strong>1 B.0061/Roum-PDT/II/2<strong>01</strong>1 Kementerian Pembangunan Daerah Tertinggal 28/04/11 09/08/11 1619883160009Pusat Analis dan Harmonisasi Kebijakan Setjend502 07/<strong>03</strong>/2<strong>01</strong>1 S-99/AH/2<strong>01</strong>005/05/11 09/08/11 1619883130002Kementerian Keuangan RI5<strong>03</strong> 07/<strong>03</strong>/2<strong>01</strong>1 - Setda Pemkab Kutai Kartanegara Sertifikat Masih Berlaku504 08/<strong>03</strong>/2<strong>01</strong>1 660/131/BLH/III/2<strong>01</strong>1 Badan Lingkungan Hidup Kota Pangkalpinang 05/05/11 09/08/11 1619883100005505 08/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/312/2<strong>01</strong>1Dinas Perhubungan Komunikasi dan InformatikaPemkab Pekalongan05/05/11 12/08/11 1619883770000Sama Dengan <strong>No</strong>. Surat<strong>027</strong>/312/2<strong>01</strong>1Hal 24

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>506 08/<strong>03</strong>/2<strong>01</strong>1 529/1.712.3Sudin Pendidikan Menengah Kota Administrasi JaktimDinas Pendidikan Pemprov DKI JakartaSudah lulus ujian507 08/<strong>03</strong>/2<strong>01</strong>1 Um.002/6/8-BLTD-2<strong>01</strong>1 Balitbang Kementerian Perhubungan 20/05/11 09/08/11 1619883170008508 08/<strong>03</strong>/2<strong>01</strong>1 Um.002/1/21-PMTM-2<strong>01</strong>1 Balitbang Kementerian Perhubungan 20/05/11 09/08/11 16198831400<strong>01</strong>509 08/<strong>03</strong>/2<strong>01</strong>1 021/174/APP/II/2<strong>01</strong>1 Setda Pemkot Mataram 20/05/11 26/07/11 1619883590004510 08/<strong>03</strong>/2<strong>01</strong>1 520/78/Bapp-III/2<strong>01</strong>1 Bappeda Pemkab Kotawaringin Barat 05/05/11 26/07/11 16198822200<strong>01</strong>511 08/<strong>03</strong>/2<strong>01</strong>1 910/1129/2<strong>01</strong>1 RS Jiwa Pemerintah Aceh 05/05/11 26/07/11 1619882190007512 08/<strong>03</strong>/2<strong>01</strong>1 800/341/V.Disdiknas.OT/2<strong>01</strong>1Dinas Pendidikan Nasional Pemkab Ogan KomeringUlu Timur20/05/11 26/07/11 1619884780008513 08/<strong>03</strong>/2<strong>01</strong>1 175/DBM&SDA/2<strong>01</strong>1 Dinas Bina Marga dan Sumber Daya Air Pemkab Dairi 05/05/11 26/07/11 1619882160000514 08/<strong>03</strong>/2<strong>01</strong>1 485/H38.13/TU.00.04/2<strong>01</strong>1Lembaga Pengabdian Kepada Masyarakat Univ. NegeriSurabaya KemendiknasSertifikat Masih Berlaku515 08/<strong>03</strong>/2<strong>01</strong>1 029/LPKPD-S/III/2<strong>01</strong>1 Lembaga Pengkajian Kapasitas Pemerintahan Daerah 27/04/11 26/07/11 1619882320008516 09/<strong>03</strong>/2<strong>01</strong>1 44/800/Bappeda/II/2<strong>01</strong>1Badan Perencanaan Pembangunan, Penelitian,Pengembangan, dan Penanaman Modal Daerah(BAPPELITBANG dan PMD) Pemkab BolaangMongondow Selatan12/05/11 26/07/11 1619882330007517 09/<strong>03</strong>/2<strong>01</strong>1 170/PPs.BTG/TU.210/III/2<strong>01</strong>1Pelabuhan Perikanan Samudera Bitung DirjendPerikanan Tangkap Kementerian Kelautan dan02/05/11 26/07/11 1619882230000Perikanan518 09/<strong>03</strong>/2<strong>01</strong>1 70/-084.2Planetarium & Observarium Dinas PendidikanPemprov DKI Jakarta02/05/11 26/07/11 1619882170009519 09/<strong>03</strong>/2<strong>01</strong>1 B/690/III/2<strong>01</strong>1/Pusdokkes Pusdokkes Mabes POLRI Sudah lulus ujian520 09/<strong>03</strong>/2<strong>01</strong>1 UM.<strong>01</strong>.11-Sl/161 Pusdiklat Setjend Kementerian PU 20/05/11 26/07/11 1619882140002521 09/<strong>03</strong>/2<strong>01</strong>1 06/SK/KPA-JB/III/2<strong>01</strong>1 Satker Pengembangan Perkeretaapian Jawa Barat 04/05/11 26/07/11 16198822000<strong>03</strong>522 09/<strong>03</strong>/2<strong>01</strong>1 050/41/Ev.Bang Setda Pemkot Bontang 12/05/11 12/05/11 1580737840005523 09/<strong>03</strong>/2<strong>01</strong>1 -Satker Direktorat Pengembangan Permukiman DirjendCipta Karya Kementerian PUSudah lulus ujian524 09/<strong>03</strong>/2<strong>01</strong>1 890/347/VII/2<strong>01</strong>1 Setda Pemkab Belitung Timur Sertifikat Masih Berlaku525 09/<strong>03</strong>/2<strong>01</strong>1 050/0095/430.812/2<strong>01</strong>1 Dinas Pengairan Pemkab Bondowoso 02/05/11 26/07/11 1619882270006526 09/<strong>03</strong>/2<strong>01</strong>1 602/66/405.25/2<strong>01</strong>1Kantor Pemberdayaan Perempuan dan PerlindunganAnak Pemkab PonorogoSertifikat Masih BerlakuHal 25

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>527 10/<strong>03</strong>/2<strong>01</strong>1 800/00528 Setda Pemkab Temanggung 15/07/11 04/10/11 1619889150004528 10/<strong>03</strong>/2<strong>01</strong>1 KP.06.02/B2PJN VII/2<strong>01</strong>1/186Balai Besar Pelaksanaan Jalan Nasional VII DirjendBina Marga Kementerian PU529 10/<strong>03</strong>/2<strong>01</strong>1 800/237/Skr-DPRD/2<strong>01</strong>1 Sekretariat DPRD Kabupaten Labuhanbatu 04/05/11 24/08/11 1619884860007530 10/<strong>03</strong>/2<strong>01</strong>1 893.3/0496/20/2<strong>01</strong>1Dinas Pertanian Perkebunan dan Kehutanan PemkabBoyolaliPersyaratan tidak lengkapSudah lulus ujian531 10/<strong>03</strong>/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/22/II/2<strong>01</strong>1 Dinas Pekerjaan Umum Pemprov. NTT Persyaratan tidak lengkap532 10/<strong>03</strong>/2<strong>01</strong>1 800/2<strong>03</strong>/Binpro Setda Pemkab Tasikmalaya 12/05/11 26/07/11 1619882280005533 10/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/099/APP Bupati Sumbawa 30/<strong>03</strong>/11 24/08/11 1619885040002534 10/<strong>03</strong>/2<strong>01</strong>1 151/D.IV.3/<strong>LKPP</strong>/<strong>03</strong>/2<strong>01</strong>1 Plt. Direktur Penanganan Permasalahan Hukum <strong>LKPP</strong> 05/05/11 26/07/11535 10/<strong>03</strong>/2<strong>01</strong>1 991.10/156/DishubkominfoDinas Perhubungan Komunikasi dan InformatikaPemkot Banjarmasin05/05/11 26/07/11 1619882300000536 10/<strong>03</strong>/2<strong>01</strong>1 024.2/1141/2<strong>01</strong>1 Setda Pemkab Purworejo 05/05/11 09/08/11 1619883220000537 10/<strong>03</strong>/2<strong>01</strong>1 AP.600/80/III/2<strong>01</strong>1 Setda Pemkab Belu 31/05/11 05/08/11 1619883350004538 10/<strong>03</strong>/2<strong>01</strong>1 050/048/I/2<strong>01</strong>1 Dinas Bina Marga Pemkab Grobogan 04/05/11 24/08/11 1619884780008539 10/<strong>03</strong>/2<strong>01</strong>1 045/387/419.41/2<strong>01</strong>1 Dinas Kesehatan Pemkot Kediri 27/04/11 15/07/11 1619880760004540 11/<strong>03</strong>/2<strong>01</strong>1 525/296/III/Disbun/2<strong>01</strong>1 Dinas Perkebunan Pemprov Sulawesi Barat 05/05/11 24/08/11 1619884890004541 11/<strong>03</strong>/2<strong>01</strong>1 421.9/182/2<strong>01</strong>1Dinas Pendidikan, Kebudayaan dan Pariwisata PemkabBombana542 11/<strong>03</strong>/2<strong>01</strong>1 972/-077 Setda Pemprov DKI Jakarta 02/05/11 12/08/11 1619883590004543 11/<strong>03</strong>/2<strong>01</strong>1 SP-45/WKN.10/KNL 04<strong>01</strong>/2<strong>01</strong>1544 11/<strong>03</strong>/2<strong>01</strong>1 690.23/PDAM/MUBA/III/2<strong>01</strong>1KPKN dan Lelang Jember Kanwil X Surabaya DirjendKekayaan Negara Kementerian KeuanganPDAM Tirta Randik Kab Musi Banyuasin PemkabMusi Banyuasin02/05/11 24/08/11 1619884810002Persyaratan tidak lengkapSudah lulus ujian545 11/<strong>03</strong>/2<strong>01</strong>1 893/427 Disnaker dan Kependudukan Pemprov Papua 04/05/11 24/08/11 1619884870006546 11/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/379-Pemb Setda Kota Pemkot Tangerang 04/05/11 09/08/11 1619883260006547 11/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/008/ULP/III/2<strong>01</strong>1 ULP Pemkab Sumbawa Barat 02/05/11 09/08/11 1619883190006548 11/<strong>03</strong>/2<strong>01</strong>1 HM.<strong>03</strong>.<strong>01</strong>.94.<strong>03</strong>.11 Badan POM RI Bandung 04/05/11 24/08/11 1619884920008549 11/<strong>03</strong>/2<strong>01</strong>1 B.262/P2KTrans-PT2/III/2<strong>01</strong>1Dirjend Pembinaan Pembangunan KawasanTransmigrasi Kemenakertrans02/05/11 05/08/11 1619883340005Hal 26

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>550 11/<strong>03</strong>/2<strong>01</strong>1 - Kementerian Agama Kanwil Provinsi Jambi Persyaratan tidak lengkap551 11/<strong>03</strong>/2<strong>01</strong>1 900/090/409.107/2<strong>01</strong>1Dinas Perhubungan, Komunikasi dan InformatikaPemkab Blitar552 11/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>.2/04654Badan Perencanaan Pembangunan Daerah PemprovJawa Tengah02/05/11 05/08/11 1619883310008553 11/<strong>03</strong>/2<strong>01</strong>1 600.800/133/DPU-SEK/2<strong>01</strong>1 Dinas Pekerjaan Umum Pemkab Sigi 02/05/11 05/07/11 16198832900<strong>03</strong>554 11/<strong>03</strong>/2<strong>01</strong>1 279/084.6Dinas Pendidikan Dasar Pemkot Administrasi JakartaSelatanSudah lulus ujianPersyaratan tidak lengkap555 11/<strong>03</strong>/2<strong>01</strong>1 Um.<strong>01</strong>.<strong>01</strong>.SR-PU/07 Setjend Kementerian PU Persyaratan tidak lengkap556 11/<strong>03</strong>/2<strong>01</strong>1 234/I/3/9/2<strong>01</strong>1Pusat Kajian dan Diklat Aparatur I LembagaAdministrasi Negara557 11/<strong>03</strong>/2<strong>01</strong>1 222/KU.510/K.1/2/2<strong>01</strong>1 Badan Ketahanan Pangan Kementerian Pertanian558 14/<strong>03</strong>/2<strong>01</strong>1 640/161/Dalminbang/2<strong>01</strong>1 Setda Kota Pemkot Payakumbuh 05/05/11 05/08/11 1619881950008Persyaratan tidak lengkapPersyaratan tidak lengkap;Sama dengan <strong>No</strong>. Surat874/KU.150/K.1/9/2<strong>01</strong>1559 14/<strong>03</strong>/2<strong>01</strong>1 619/61A/Kumindag-BDinas Koperasi, UMKM, Perindustrian danPerdagangan Pemkab Sambas560 14/<strong>03</strong>/2<strong>01</strong>1 B/675/III/2<strong>01</strong>1 Badiklat Kementerian PErtahanan 24/06/11 12/08/11 1619883390000Persyaratan tidak lengkap561 14/<strong>03</strong>/2<strong>01</strong>1 <strong>03</strong>0/08819 Badiklat Pemprov Jawa Tengah 06/07/11 13/08/11 1619883300009562 14/<strong>03</strong>/2<strong>01</strong>1 800/SET/256/184563 14/<strong>03</strong>/2<strong>01</strong>1 157/J5.1/KP/2<strong>01</strong>1564 14/<strong>03</strong>/2<strong>01</strong>1 79/PEN.5/3/2<strong>01</strong>1Dinas Kelautan Perikanan, Pertanian dan KehutananPemkot BatamPusat Pengembangan dan Pemberdayaan Pendidik danTenaga Kependidikan Bahasa KemendiknasDirjend Pengembangan Ekspor Nasional KementerianPerdagangan RI04/05/11 24/08/11 161988502000402/05/11 24/08/11 161988500000605/04/11 05/08/11 1619883200002565 15/<strong>03</strong>/2<strong>01</strong>1 028/<strong>03</strong>06/Dinpendik/Sekr./II/2<strong>01</strong>1 Dinas Pendidikan Pemkot Pangkalpinang 12/08/11 06/09/11 1619885560005566 15/<strong>03</strong>/2<strong>01</strong>1 UM.<strong>01</strong>.11-KP/46Pusat Pembinaan Penyelenggaraan Konstruksi - BadanPembinaan Kontruksi - Kementerian PU26/<strong>03</strong>/11 26/04/11 1561617920000567 15/<strong>03</strong>/2<strong>01</strong>1 789/PL.430/I.1/2/2<strong>01</strong>1 Balitbang Pertanian Kementerian Pertanian 04/05/11 05/08/11 16198819200<strong>01</strong>568 15/<strong>03</strong>/2<strong>01</strong>1 600/235/DPU-PAS/2<strong>01</strong>1 Dinas Pekerjaan Umum Pemkab Pasaman 12/05/11 24/08/11 1619884930007569 15/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/509/Pemb. Setda Pemkab Purwakarta Persyaratan tidak lengkap570 15/<strong>03</strong>/2<strong>01</strong>1 S-12/WPJ.22/BG.<strong>01</strong>04/2<strong>01</strong>1Dirjend Pajak Kanwil DJP Jawa Barat II KementerianKeuangan RI02/05/11 05/08/11 1619883280004571 15/<strong>03</strong>/2<strong>01</strong>1 800/512/405.29/2<strong>01</strong>1 RSUD Dr. Harjono S. Pemkab Ponorogo 04/05/11 06/08/11 1619884830000Hal 27

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>572 15/<strong>03</strong>/2<strong>01</strong>1 S.504/SET-3/2<strong>01</strong>1Dirjend Bina Pengelolaan Daerah Aliran Sungai danPerhutanan Sosial Kementerian Kehutanan02/05/11 05/08/11 16198833600<strong>03</strong>573 15/<strong>03</strong>/2<strong>01</strong>1 024/0282/Asset-DPPKADDinas Pendapatan, Pengelolaan Keuangan dan AsetDaerah Kabupaten Tolitoli Pemkab Tolitoli23/05/11 24/08/11 16198849700<strong>03</strong>574 16/<strong>03</strong>/2<strong>01</strong>1 525/420/TU-1 Dinas Perkebunan Pemprov Kalimantan Selatan 05/05/11 05/08/11 1619883230009575 16/<strong>03</strong>/2<strong>01</strong>1 S-475/WPJ.04/2<strong>01</strong>1Kanwil DJP Jakarta Selatan Dirjen Pajak KementerianKeuangan02/05/11 05/08/11 1619883300009576 16/<strong>03</strong>/2<strong>01</strong>1 16510.0561 Badan Pusat Statistik Prov. Sumatera Selatan 04/05/11 24/08/11 16198849900<strong>01</strong>577 16/<strong>03</strong>/2<strong>01</strong>1 286-3/083Sudin Pendidikan Dasar Kota Administrasi JakartaBarat Pemkot Adm. Jakarta Barat578 16/<strong>03</strong>/2<strong>01</strong>1 - an Afrida Berlini <strong>03</strong>/<strong>03</strong>/11 26/04/11 1561618570006579 16/<strong>03</strong>/2<strong>01</strong>1 KU.<strong>03</strong><strong>01</strong>/BP.05/0242/2<strong>01</strong>1580 16/<strong>03</strong>/2<strong>01</strong>1 S-054/WPJ.12/KP.<strong>03</strong>/2<strong>01</strong>1Direktorat Bina Program Dirjend Bina MargaKementerian PUKPP Pratama Tulungagung Kanwil DJP Jawa Timur IIIDirjend Pajak Kementerian Keuangan05/05/11 05/08/11 1619881860000Persyaratan tidak lengkapPersyaratan tidak lengkap581 16/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/140/Pemb. Setda Pemkab Bandung Barat 04/05/11 12/08/11 1619883560007582 16/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/<strong>03</strong>61/Bina Program/2<strong>01</strong>1 Setda Pemkab Karo 04/05/11 24/08/11 1619884830000583 16/<strong>03</strong>/2<strong>01</strong>1 800/2<strong>01</strong>/DISHUBKOMINPAR/III/2<strong>01</strong> Dinas Perhubungan, komunikasi, Informatika, dan1Pariwisata Pemkot Banjar19/04/11 24/08/11 1619884940006584 16/<strong>03</strong>/2<strong>01</strong>1 1599/DPT.0/KU.540.S1/III/2<strong>01</strong>1Dirjend Perikanan Tangakap Kementerian Kelautandan Perikanan04/05/11 12/08/11 1619883<strong>03</strong>0005585 16/<strong>03</strong>/2<strong>01</strong>1 800/755/X/2<strong>01</strong>0 Setda Pemkab Musi Banyuasin 05/05/11 24/08/11 1619884840009586 16/<strong>03</strong>/2<strong>01</strong>1 UM.02.06.CS3/III/2<strong>01</strong>1kepala bagian hukum dan perundangundangan DirjendCipta Karya Kementerian PU15/07/11 24/08/11 1619885<strong>03</strong>00<strong>03</strong>587 16/<strong>03</strong>/2<strong>01</strong>1 KP.510/19/2<strong>01</strong>1 Setjend MPR 23/05/11 24/08/11 1619884960004588 16/<strong>03</strong>/2<strong>01</strong>1 S-210/WBC.05/KPP.02/2<strong>01</strong>1Kantor Pengawasan dan Pelayanan Bea dan Cukai TipeA2 Jambi Kanwil DJBC Sumatera Bagian SelatanDirjend Bea Cukai Kementerian Keuangan26/05/11 12/08/11 16198834500<strong>01</strong>589 16/<strong>03</strong>/2<strong>01</strong>1 560/<strong>03</strong>61/2<strong>01</strong>1Dinas Sosial, Tenaga Kerja dan Mobilitas PendudukPemkab Aceh Utara04/05/11 12/08/11 1619883400006590 16/<strong>03</strong>/2<strong>01</strong>1 31000.180 Badan Pusat Statistik Prov. DKI Jakarta 04/05/11 19/08/11 1619884900000591 Badan Pusat Statistik Prov. DKI Jakarta 24/06/11 20/08/11 1616407180000BLUD Puskesmas Kecamatan Menteng Dinas592 16/<strong>03</strong>/2<strong>01</strong>1 65/084.218/04/11 12/08/11 1619883090009Kesehatan Pemprov DKI Jakarta593 16/<strong>03</strong>/2<strong>01</strong>1 045.2/13/ASS.II/2<strong>01</strong>1 Setda Pemprov Kepulauan Bangka Belitung Persyaratan tidak lengkapHal 28

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>594 16/<strong>03</strong>/2<strong>01</strong>1 Kw.13.1/5/Ks.<strong>01</strong>.7/785/2<strong>01</strong>1 Kementerian Agama Kanwil Provinsi Jawa Timur <strong>01</strong>/07/11 12/08/11 1619883620008595 17/<strong>03</strong>/2<strong>01</strong>1 041/330/UIPKITRINGKAL/2<strong>01</strong>1Unit Induk Pembangunan Pembangkit dan JaringanKalimantan PT.PLN (Persero)18/04/11 05/10/11 1619889060006596 17/<strong>03</strong>/2<strong>01</strong>1 PH.346/<strong>01</strong>/<strong>01</strong>/AD.BTG/11Kantor Administrator Pelabuhan Kls I Bitung DirjendPerhubungan Laut Kementerian Perhubungan597 17/<strong>03</strong>/2<strong>01</strong>1 S-081/WPJ.26/KP.<strong>03</strong><strong>01</strong>/2<strong>01</strong>1KPP Pratama Rantau Prapat Dirjend Pajak KanwilSumut II Kementerian Keuangan18/04/11 24/08/11 16198848000<strong>03</strong>598 17/<strong>03</strong>/2<strong>01</strong>1 600/314/Adm. Pemb Setda Pemprov. Nusa Tenggara Barat 12/05/11 12/08/11 1619883600000599 17/<strong>03</strong>/2<strong>01</strong>1 S.43/VI/BP2HP-VII/1/2<strong>01</strong>1Balai Pemantauan Pemanfaatan Hutan ProduksiWilayah VII Dirjend Bina Usaha Kehutanan11/<strong>03</strong>/11 14/04/11 1561616710008Kementerian Kehutanan600 17/<strong>03</strong>/2<strong>01</strong>1 PL.02.<strong>01</strong>-Bt/07Dirjend Bina Teknik Dirjend Bina Marga KementerianPU12/05/11 12/08/11 16198835800056<strong>01</strong> 17/<strong>03</strong>/2<strong>01</strong>1 UM <strong>01</strong>.11-SL.05/18.a Badiklat PU Wil. V Makassar Pusdiklat Setjend PU 19/04/11 12/08/11 1619883370002Sertifikat Masih Berlaku602 17/<strong>03</strong>/2<strong>01</strong>1 ..../B.5/III/2<strong>01</strong>1 Setda Pemkab Mukomuko 04/05/11 12/08/11 16198835100026<strong>03</strong> 17/<strong>03</strong>/2<strong>01</strong>1 600/PU-BM/365 Dinas PU Pemprov Riau 12/05/11 12/08/11 1619883550008604 17/<strong>03</strong>/2<strong>01</strong>1 - An Achmad Djunaidi & Margalis Persyaratan tidak lengkap605 17/<strong>03</strong>/2<strong>01</strong>1 Um.<strong>01</strong>.11-Sh/120 kepala Biro Hukum Setjend Kementerian PU 12/05/11 12/08/11 1619883440002606 17/<strong>03</strong>/2<strong>01</strong>1 506/59/BP2MPBJ/II/2<strong>01</strong>1Badan Perizinan Penanaman Modal PBJ PemkabDharmasraya11/05/11 12/08/11 1619883410005607 17/<strong>03</strong>/2<strong>01</strong>1 810/Pol.PP/II/2<strong>01</strong>1/042 Kantor Polisi Pamong Praja Pemkab Kuantan Singingi 11/05/11 12/08/11 1619883610009608 17/<strong>03</strong>/2<strong>01</strong>1 Pemb.500/14.a/53.17/I/2<strong>01</strong>1 Bagian Pembangunan Setda Pemkab Sumba Tengah Persyaratan tidak lengkap609 18/<strong>03</strong>/2<strong>01</strong>1 000/321/Disnakertrans Disnakertrans Pemprov Kalimantan Selatan 04/05/11 11/08/11 1580739190009610 18/<strong>03</strong>/2<strong>01</strong>1 510.2/358/PEMB Walikota Tarakan 04/05/11 12/08/11 1619883570006611 18/<strong>03</strong>/2<strong>01</strong>1 800/254/Sekret Dinas Tata Ruang dan Permukiman Pemkab Cianjur Persyaratan tidak lengkap612 18/<strong>03</strong>/2<strong>01</strong>1 1279/-077 Dinas Pendidikan Pemprov DKI Jakarta Persyaratan tidak lengkap613 18/<strong>03</strong>/2<strong>01</strong>1 196/078.2614 18/<strong>03</strong>/2<strong>01</strong>1 PH.346/<strong>01</strong>/<strong>01</strong>/UPP.MGR-11Dinas Komunikasi Informatika dan KehumasanPemprov DKI JakartaKantor Unit Penyelenggara Pelabuhan Kelas I ManggarDirjend Perhubungan Kementerian Perhubungan<strong>03</strong>/<strong>03</strong>/11 15/04/11 156161730000002/05/11 12/08/11 16198835200<strong>01</strong>Hal 29

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>615 18/<strong>03</strong>/2<strong>01</strong>1 028/294/2<strong>01</strong>1 BKD Pemkab Gunungkidul 02/05/11 12/08/11 1619883490007616 18/<strong>03</strong>/2<strong>01</strong>1 513/-084.6 RSUD Budhi Asih Dinas Kesehatan DKI Jakarta 12/07/11 12/08/11 1619883470009617 18/<strong>03</strong>/2<strong>01</strong>1 66/F.40/KP/2<strong>01</strong>1 LPMP Prov. Sulawesi Utara Kemendiknas Persyaratan tidak lengkap618 18/<strong>03</strong>/2<strong>01</strong>1 600.<strong>01</strong>/20/TRBK/2<strong>01</strong>1 Dinas PU Pemprov. Kalimantan Selatan 05/05/11 12/08/11 1619883060002619 18/<strong>03</strong>/2<strong>01</strong>1 873/0430/BKD Pemkab Sleman (badan kepegawian daerah) 12/05/11 16/09/11 1619886780006620 18/<strong>03</strong>/2<strong>01</strong>1 050/1139 Setda Pemkab Tegal 12/05/11 12/08/11 1619883540009621 18/<strong>03</strong>/2<strong>01</strong>1 B.177/BalitbangKP.0/DL.120/<strong>03</strong>/2<strong>01</strong>1Balitbang Kelautan dan Perikanan KementerianKelautan dan Perikanan12/05/11 12/08/11 1619883930008622 18/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/286 Badan Arsip dan Perpustakaan Pemprov. Jawa Tengah 04/05/11 19/08/11 1619884790007KPP Pratama Gresik Selatan Kanwil Jatim II Dirjend623 18/<strong>03</strong>/2<strong>01</strong>1 S-<strong>01</strong>/WPJ.24/KP.10/2<strong>01</strong>102/07/11 12/08/11 16198837600<strong>01</strong>Pajak Kementerian Keuangan624 21/<strong>03</strong>/2<strong>01</strong>1 410/486/Pemb/2<strong>01</strong>1 Setda Pemkab Humbang Hasundutan Persyaratan tidak lengkap625 21/<strong>03</strong>/2<strong>01</strong>1 310/DPU-S/III/2<strong>01</strong>1 Dinas Pekerjaan Umum Pemkab Indragiri Hulu 12/05/11 06/09/11 1619885530008Balai Wilayah Sungai Sumatera-I Dirjend Sumber626 21/<strong>03</strong>/2<strong>01</strong>1 UM.<strong>01</strong>.02/BWS.SI12/05/11 12/08/11 1619883530000Daya Air Kementerian PU627 21/<strong>03</strong>/2<strong>01</strong>1 059/SET.Umum/<strong>03</strong>.11 Pemkab Kepuluan Anambas Kec. Palmatak Persyaratan tidak lengkap628 21/<strong>03</strong>/2<strong>01</strong>1 870/35/DPU/III/2<strong>01</strong>1 Dinas PU Pemkab Majene 05/05/11 06/09/11 1619885510000629 21/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/1066/410.207.3/2<strong>01</strong>1 Setda Pemkot Blitar Persyaratan tidak lengkap630 21/<strong>03</strong>/2<strong>01</strong>1 188.3/002 Dinas Permukiman dan Tata Ruang Pemkot Tegal Persyaratan tidak lengkap631 21/<strong>03</strong>/2<strong>01</strong>1 800/<strong>03</strong>/D.2/Diklat Badiklat Pemprov Bengkulu Perbaikan NIP632 21/<strong>03</strong>/2<strong>01</strong>1 600/288/DBM/2<strong>01</strong>1 Dinas Bina Marga Pemkab Simalungun 12/05/11 12/08/11 1619883730004633 21/<strong>03</strong>/2<strong>01</strong>1 360/1<strong>01</strong>3/BPBD-SS/2<strong>01</strong>1Badan Penanggulangan Bencana Daerah PemprovSumatera Selatan05/05/11 06/09/11 16198856700<strong>01</strong>634 21/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/02630/Setwan/2<strong>01</strong>1 Sekretariat DPRD Pemprov Sumatera Selatan 12/05/11 06/09/11 1619885700005635 21/<strong>03</strong>/2<strong>01</strong>1 050/2<strong>01</strong>/Adm.Pemb/III/2<strong>01</strong>1 Setda Pemkab Soppeng 11/<strong>03</strong>/11 12/08/11 1619883630007636 21/<strong>03</strong>/2<strong>01</strong>1 000/2468/1<strong>01</strong>.1/2<strong>01</strong>1 Dinas Kesehatan Pemprov Jawa Timur Persyaratan tidak lengkap637 21/<strong>03</strong>/2<strong>01</strong>1 S-180/AG.1/2<strong>01</strong>1 Setditjend Anggaran Kementerian Keuangan 05/05/11 06/09/11 1619885460008Hal 30

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>638 21/<strong>03</strong>/2<strong>01</strong>1 Kw.11.1/5/HM.00/2<strong>01</strong>1/2<strong>01</strong>1 Kementerian Agama Kanwil Prov. Jawa Tengah 05/05/11 06/09/11 1619885540007639 21/<strong>03</strong>/2<strong>01</strong>1 -Badan Perencanaan Pembangunan Daerah PemkabKutai Kartanegara12/05/11 06/09/11 1619885480006640 21/<strong>03</strong>/2<strong>01</strong>1 1133/H38/KU.<strong>01</strong>.<strong>01</strong>/2<strong>01</strong>0 Universitas Negeri Surabaya Kemendiknas 12/05/11 06/09/11 1619885660002641 21/<strong>03</strong>/2<strong>01</strong>1 W11.U/1122/UM.02.02/III/2<strong>01</strong>1 Pengadilan Tinggi Bandung 05/05/11 06/09/11 1619885690009642 21/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/117A/DistankanakDinas Pertanian Perikanan dan Peternakan PemkabSanggau05/05/11 06/09/11 16198857200<strong>03</strong>643 21/<strong>03</strong>/2<strong>01</strong>1 005/1416 Setda Pemkab jepara 12/05/11 12/08/11 1619883700007644 21/<strong>03</strong>/2<strong>01</strong>1 600/<strong>03</strong>80/423.021/2<strong>01</strong>1Bagian Administrasi Pembangunan Setda KotaPasuruan02/07/11 12/08/11 1619883640006645 21/<strong>03</strong>/2<strong>01</strong>1 237/SET-2<strong>01</strong>1/900 Dinas Kesehatan Pemkab Natuna 12/05/11 12/08/11 16198835000<strong>03</strong>Setjend Pusat Pengawasan Mutu Barang Kementerian646 21/<strong>03</strong>/2<strong>01</strong>1 211/SJ-DAG.9.UPT.BS.1/3/2<strong>01</strong>123/05/11 06/09/11 1619885440000Perdagangan647 24/<strong>03</strong>/2<strong>01</strong>1 467.1/2104 Dinas Sosial Pemerintah Aceh Persyaratan tidak lengkap648 24/<strong>03</strong>/2<strong>01</strong>1 Pemb.500/14/53.17/I/2<strong>01</strong>1 Bagian Pembangunan Setda Pemkab Sumba Tengah Persyaratan tidak lengkap649 24/<strong>03</strong>/2<strong>01</strong>1 1024/RSUD/UM/III/2<strong>01</strong>1 RSU Pemprov Kepulauan Riau <strong>01</strong>/08/11 06/09/11 1619885550006650 24/<strong>03</strong>/2<strong>01</strong>1 738/-084.32Sekretariat Kota Administrasi Jakarta Timur PemprovDKI Jakarta<strong>01</strong>/08/11 06/09/11 1619885520009651 24/<strong>03</strong>/2<strong>01</strong>1 050/Adm.Pemb/III/2<strong>01</strong>1/ Setda Pemkab Siak <strong>01</strong>/08/11 06/09/11 1619885490005652 23/<strong>03</strong>/2<strong>01</strong>1 800.05/502/DPU Dinas PU Pemprov Bali 04/05/11 12/08/11 16198833800<strong>01</strong>653 23/<strong>03</strong>/2<strong>01</strong>1 445/302/TU RSUD Soreang Pemkab Bandung <strong>01</strong>/08/11 19/08/11 1619884710005654 23/<strong>03</strong>/2<strong>01</strong>1 893.3/188/III/2<strong>01</strong>1 Dinas PU Pemprov Kalimantan Timur 10/06/11 19/08/11 16198846800<strong>01</strong>655 24/<strong>03</strong>/2<strong>01</strong>1 523/85/DIKAN/SET-C Dinas Perikanan Pemerintah Kab. Kapuas Hulu 11/05/11 19/08/11 16198848200<strong>01</strong>656 24/<strong>03</strong>/2<strong>01</strong>1 88/BU/III/2<strong>01</strong>1 Sekretariat kementrian Riset dan Teknologi 11/05/11 19/08/11 1619884910009657 24/<strong>03</strong>/2<strong>01</strong>1 551.10/156/Dishubkominfo658 24/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/842/2<strong>01</strong>1Dinas perhubungan komunikasi dan informatikaBanjarmasinBadan ketahanan pangan dan penyuluhan PemerintahKab. Aceh Utara11/05/11 18/08/11 1619884700006659 24/<strong>03</strong>/2<strong>01</strong>1 560/0535/DPKKD/2<strong>01</strong>1Dinas Pengelolaan keuangan dan kekayaan daerahpemerintah Kab. Aceh Utara11/05/11 18/08/11 1619884580004660 25/<strong>03</strong>/2<strong>01</strong>1 800/DISHUBPOSTEL/2<strong>01</strong>1/58 DISHUBPOSTEL Kab. NATUNA 11/05/11 18/08/11 1619884550007Persyaratan tidak lengkapHal 31

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>661 25/<strong>03</strong>/2<strong>01</strong>1 050/<strong>027</strong>/380/SEK Dinas kelautan dan Perikanan Prov. Sulawesi Tengah Persyaratan tidak lengkap662 22/<strong>03</strong>/2<strong>01</strong>1 064/H37.5.6/TU/2<strong>01</strong>1Kepala Unit Layanan Pengadaan Universitas NegeriSemarang Kemendiknas<strong>01</strong>/08/11 12/08/11 16198834300<strong>03</strong>663 22/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/223/PEMB/2<strong>01</strong>1 Setda Pemkab Hulu Sungai Tengah 12/05/11 12/08/11 1619883460000664 22/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/517/437.58/2<strong>01</strong>1 Disnaker Pemkab Gresik 02/05/11 19/08/11 1619884670002665 22/<strong>03</strong>/2<strong>01</strong>1 .../III/IV/B.9/2<strong>01</strong>1 Setda Pemprov Bengkulu Persyaratan tidak lengkap666 22/<strong>03</strong>/2<strong>01</strong>1 600/518/422.021/2<strong>01</strong>1 Setda Pemkot Batu 12/05/11 12/08/11 1619883680002667 22/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/304/Um668 22/<strong>03</strong>/2<strong>01</strong>1 UM.<strong>01</strong>.11/BBWS.SO/184669 22/<strong>03</strong>/2<strong>01</strong>1 800/176/DISHUBKOMINFO/III/2<strong>01</strong>1670 22/<strong>03</strong>/2<strong>01</strong>1 Um.<strong>01</strong>.<strong>03</strong>-Lp.10/64Balai Pengawasan dan Sertifikasi Benih TanamanPangan dan Hortikultura Dinas Pertanian TanamanPangan Pemprov Jawa BaratBalai Besar Wilayah Sungai Serayu Opak Dirjend SDAKementerian PUDinas Perhubungan, Komunikasi dan InformatikaPemkab Bangka SelatanBalai Pengembangan Teknologi PerumahanTradisional Denpasar - Puslitbang PermukimanBalitbang Kemen PU02/05/11 12/08/11 16198837400<strong>03</strong><strong>01</strong>/08/11 12/08/11 161988364000623/05/11 13/08/11 1611495780002<strong>01</strong>/08/11 12/08/11 1619883650005671 22/<strong>03</strong>/2<strong>01</strong>1 893/973/BKD, DIKLAT Setda Pemkab Badung Bali Persyaratan tidak lengkap672 29/<strong>03</strong>/2<strong>01</strong>1 IK.<strong>01</strong>.06/<strong>01</strong>/BWSS-III/2<strong>01</strong>1Balai Wilayah Sungai Sumatera III Dirjend SDAKementerian PU05/05/11 19/08/11 1619884850008673 29/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/92/<strong>03</strong> Setda Pemkab Klaten 08/06/11 06/09/11 1619885470007674 29/<strong>03</strong>/2<strong>01</strong>1 600/PU-BM/400 kepala Dinas PU Pemprov Riau 12/05/11 28/09/11 1619887120009675 29/<strong>03</strong>/2<strong>01</strong>1 209/DBM-Sekrt/III/2<strong>01</strong>1 Dinas Bina Marga Pemkot Banjarmasin 12/05/11 12/08/11 16198836700<strong>03</strong>676 29/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/186/437.55/2<strong>01</strong>1 Dinas Perhubungan Pemkab Gresik 11/05/11 13/08/11 1580738590008677 29/<strong>03</strong>/2<strong>01</strong>1 372/SJ/KOMINFO/3/2<strong>01</strong>1 Sekjend Kementerian Komunikasi dan Informatika 10/06/11 20/09/11 1619887140007678 29/<strong>03</strong>/2<strong>01</strong>1 676/TU.210/F5.B/<strong>03</strong>.2<strong>01</strong>1Balai Penyidikan dan Pengujian Veteriner Regional IIBukittinggi Dirjend Peternakan dan Kesehatan HewanKementerian Pertanian, Persyaratan tidak lengkap679 29/<strong>03</strong>/2<strong>01</strong>1 800/117/Peg/2<strong>01</strong>1 RSUD Lukas Pemkab Nias Selatan 23/05/11 18/08/11 16198847300<strong>03</strong>680 29/<strong>03</strong>/2<strong>01</strong>1 980/100/Diklat/2<strong>01</strong>0 Setda Pemkab Belitung 31/05/11 06/09/11 16198858100<strong>01</strong>681 29/<strong>03</strong>/2<strong>01</strong>1 954/628-Pemb Setda Pemkab Cirebon <strong>01</strong>/08/11 12/08/11 1619883420004Hal 32

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>682 29/<strong>03</strong>/2<strong>01</strong>1 S-24/IAPI-SUMUT.<strong>01</strong>/2<strong>01</strong>1 IAPI DPD Sumatera Utara 10/06/11 12/08/11 16198836900<strong>01</strong>683 29/<strong>03</strong>/2<strong>01</strong>1 PL.0<strong>03</strong>/I/550-BSN Badan SAR Nasional 20/05/11 06/09/11 1619885450009684 29/<strong>03</strong>/2<strong>01</strong>1 200/273/2<strong>01</strong>1Bagian Administrasi Pembangunan Pemkab AcehUtara<strong>01</strong>/08/11 18/08/11 1619884620007685 29/<strong>03</strong>/2<strong>01</strong>1 050/04/Pemb-II/III/2<strong>01</strong>1 Setda Pemkab Nunukan 31/05/11 20/09/11 1619887170004686 29/<strong>03</strong>/2<strong>01</strong>1 - an Diyono Persyaratan tidak lengkap687 30/<strong>03</strong>/2<strong>01</strong>1 028/05/665 Setda Pemkab Kepulauan Sangihe Persyaratan tidak lengkap688 22/<strong>03</strong>/2<strong>01</strong>1 KP.02.<strong>01</strong>/11.3/267/2<strong>01</strong>1Badan Layanan Umum RSUP Prof. Dr. R.D. KandouManado31/05/11 22/09/11 1619887300005689 22/<strong>03</strong>/2<strong>01</strong>1 Um.<strong>01</strong>.11-LS/109 Badan Penelitian dan Pengembangan Kementerian PU 10/06/11 12/08/11 1619883710006690 22/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/1069/Pemb. Sekretariat Daerah Pemkab Pinrang 31/05/11 20/09/11 1619887130008691 23/<strong>03</strong>/2<strong>01</strong>1 33/-084.2692 23/<strong>03</strong>/2<strong>01</strong>1 UK.193/1/6/PLP.JKT-11693 24/<strong>03</strong>/2<strong>01</strong>1 5<strong>01</strong>/BKKPN/III/2<strong>01</strong>1Suku Dinas Perumahan dan Gedung PemerintahanDaerah Pemkot Administrasi Jakarta SelatanPangkalan Penjagaan Laut dan Pantai Kelas I TanjungPriok Dirjend Perhubungan Laut KementerianPerhubunganBalai Kawasan Konservasi Perairan Nasional DirjendKelautan, Pesisir dan Pulau-pulau Kecil KementerianKelautan dan Perikanan23/05/11 06/09/11 161988560000812/05/11 06/09/11 1619885570004Persyaratan tidak lengkap694 25/<strong>03</strong>/2<strong>01</strong>1 Sti.07/KP.02.3/591/2<strong>01</strong>1 STAIN Jember Kementerian Agama 31/05/11 12/08/11 1619883820005695 25/<strong>03</strong>/2<strong>01</strong>1 Kd.13.09/1/KS.02/394/2<strong>01</strong>1Kantor Kabupaten Jember Kementerian Agama (MINGerahan)23/05/11 12/08/11 1619883660004696 25/<strong>03</strong>/2<strong>01</strong>1 Sti.21/1/KS.00/455/2<strong>01</strong>1 STAIN Ponorogo Kementerian Agama 31/05/11 06/09/11 1619885750000697 25/<strong>03</strong>/2<strong>01</strong>1 602/DBM-PE/7882/2<strong>01</strong>1 Dinas Bina Marga Pemprov Sumatera Utara 31/05/11 06/09/11 1619885710004698 25/<strong>03</strong>/2<strong>01</strong>1 460/PPSB.A/TU.210/III/2<strong>01</strong>1Pelabuhan Perikanan Samudera Belawan DirjendPerikanan Tangkap Kementerian KP12/05/11 06/09/11 16198856500<strong>03</strong>699 25/<strong>03</strong>/2<strong>01</strong>1 99/SM.440/J.3.2/3/2<strong>01</strong>1Balai Besar Pelatihan Pertanian Batangkaluku, BadanPenyuluhan dan Pengembangan SDM Pertanian 23/05/11 06/09/11 1619885680000Kementarian Pertanian700 25/<strong>03</strong>/2<strong>01</strong>1 523/173/DPE/2<strong>01</strong>1Dinas Pertambangan dan Energi Pemkab BangkaSelatan23/05/11 06/09/11 16198855800<strong>03</strong>7<strong>01</strong> 25/<strong>03</strong>/2<strong>01</strong>1 <strong>027</strong>/1144/2<strong>01</strong>1 Dinas Kehutanan dan Perkebunan Pemkab Aceh Utara Persyaratan tidak lengkap702 25/<strong>03</strong>/2<strong>01</strong>1 S.174/VIII/BPK.Bjb‐1/2<strong>01</strong>1Balai Penelitian Kehutanan Banjarbaru BalitbangKehutanan Kementerian Kehutanan27/04/11 06/09/11 1619885630005Hal 33

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>7<strong>03</strong> 25/<strong>03</strong>/2<strong>01</strong>1 2351/LKI-K/2<strong>01</strong>1704 25/<strong>03</strong>/2<strong>01</strong>1 174/F.F18.1/LL/2<strong>01</strong>1Lembaga Kajian Indonesia - Pekanbaru Jl. KapausariUjung/Amanah <strong>No</strong>.2 Tangkerang Timur, TenayanRaya, Pekanbaru - Riau 28282LPMP Provinsi Nanggroe Aceh DarussalamKemdiknas31/05/11 15/09/11 161988676000831/05/11 16/09/11 1619886860005705 25/<strong>03</strong>/2<strong>01</strong>1 600/PU/249/2<strong>01</strong>1 Dinas PU Pemkab Siak 23/05/11 12/08/11 1619883780009706 25/<strong>03</strong>/2<strong>01</strong>1 <strong>03</strong>8/IAPI/SP/III/2<strong>01</strong>1 DPP IAPI 31/05/11 22/09/11707 25/<strong>03</strong>/2<strong>01</strong>1 426/RRI.SM/SEK/2<strong>01</strong>1 RRI - Semarang 23/05/11 12/08/11 16198837500<strong>027</strong>08 28/<strong>03</strong>/2<strong>01</strong>1 050/04/49 Setda Pemkot Tomohon 31/05/11 06/09/11 1619885620006709 28/<strong>03</strong>/2<strong>01</strong>1 267/KP.510/III/2<strong>01</strong>1Dirjend Perikanan Tangakap Pelabuhan PerikananNusantara Pengambengan Kementerian Kelautan danPerikanan08/08/11 06/09/11 16198855900<strong>027</strong>10 28/<strong>03</strong>/2<strong>01</strong>1 560/TU/III/2<strong>01</strong>1 RSUD Pemkab Natuna Persyaratan tidak lengkap711 28/<strong>03</strong>/2<strong>01</strong>1 800/856/413/2<strong>01</strong>1 Dinas Pendidikan Pemkab Jember 12/05/11 06/09/11 1619885640004712 28/<strong>03</strong>/2<strong>01</strong>1 600/141/PU-Pyk/2<strong>01</strong>1 Dinas PU Pemkot Payakumbuh 05/05/11 06/09/11 1619885610007713 28/<strong>03</strong>/2<strong>01</strong>1 174/DAGLU.2.4/3/2<strong>01</strong>1714 28/<strong>03</strong>/2<strong>01</strong>1 045.2/516/X/PHB.2<strong>01</strong>0Dirjend Perdagangan Luar Negeri KementerianPerdaganganDinas Perhubungan Komunikasi dan InformatikaPemprov Sulawesi Tenggara04/05/11 06/09/11 161988578000723/05/11 30/09/11 1619888530005715 28/<strong>03</strong>/2<strong>01</strong>1 - an Hamidah Yasin Persyaratan tidak lengkap716 28/<strong>03</strong>/2<strong>01</strong>1 S.371/Set-2/2<strong>01</strong>1717 28/<strong>03</strong>/2<strong>01</strong>1 SB.1/231/DKP-Set/2<strong>01</strong>1Dirjend Bina Usaha Kehutanan KementerianKehutananDinas Kelautan dan Perikanan Pemkab KotawaringinBarat23/05/11 30/09/11 161988778000523/05/11 22/09/11 1619887430009718 28/<strong>03</strong>/2<strong>01</strong>1 800/1636/RSEB/2<strong>01</strong>1 RS Dr. Ernaldi Bahar Pemprov Sumatera Selatan Persyaratan tidak lengkap719 28/<strong>03</strong>/2<strong>01</strong>1 025/05/665 Setda Pemkab Kepulauan Sangihe 31/05/11 15/09/11 16198868000<strong>01</strong>720 28/<strong>03</strong>/2<strong>01</strong>1 S.319/Set-2/2<strong>01</strong>1Dirjend Bina Usaha Kehutanan KementerianKehutanan23/05/11 15/09/11 1619886600007721 28/<strong>03</strong>/2<strong>01</strong>1 050/893 Setda Pemkot Surakarta 31/05/11 30/09/11 16198878700<strong>03</strong>722 28/<strong>03</strong>/2<strong>01</strong>1 B.750/P2HP.0/KP.120/III/2<strong>01</strong>1Dirjend Pengolahan dan Pemasaran Hasil PerikananKementerian Kelautan & Perikanan05/05/11 22/09/11 1619887310004Hal 34

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>723 28/<strong>03</strong>/2<strong>01</strong>1 16021/TU.220/F2.K/<strong>03</strong>.11Balai Besar Inseminasi Buatan Singosari DirjendPeternakan dan Kesehatan Hewan KementerianPertanian23/05/11 22/09/11 16198874000<strong>027</strong>24 28/<strong>03</strong>/2<strong>01</strong>1 BPPT.848/109/III/2<strong>01</strong>1 Badan Pelayanan Perijinan Terpadu Pemkot Kupang 23/05/11 30/09/11 16198884800<strong>03</strong>725 30/<strong>03</strong>/2<strong>01</strong>1 050/131/409.108/2<strong>01</strong>1 Dinas PU Bina Marga dan Pengairan Pemkab Blitar 23/05/11 22/09/11 16198873300<strong>027</strong>26 30/<strong>03</strong>/2<strong>01</strong>1 B-118/PHIJSK/SES/III/2<strong>01</strong>1Dirjend Pembinaan Hubungan Industrial dan JaminanSosial Tenaga Kerja - Kemenakertrans23/05/11 30/09/11 16198884900<strong>027</strong>27 30/<strong>03</strong>/2<strong>01</strong>1 Set.IV/Kp.02.2/1040/2<strong>01</strong>1Dirjend Bimbingan Masyarakat Katolik KementerianAgama12/05/11 15/09/11 1619886740000728 30/<strong>03</strong>/2<strong>01</strong>1 878/-085.4Dinas Pengawasan dan Penertiban Bengunan PemprovDKI Jakarta23/05/11 30/09/11 1619888510007729 30/<strong>03</strong>/2<strong>01</strong>1 1243/H6.7.1/FMIPA/TU/2<strong>01</strong>1 FMIPA Universitas Padjajaran Kemdiknas 23/<strong>03</strong>/11 <strong>01</strong>/10/11 '1561247680008730 30/<strong>03</strong>/2<strong>01</strong>1 B/610/III/2<strong>01</strong>1 Sekolah Staf dan Komando Mabes AL 12/05/11 06/09/11 16198857300<strong>027</strong>31 30/<strong>03</strong>/2<strong>01</strong>1 800/073/2<strong>01</strong>1 Setda Pemkab Rembang 28/06/11 20/09/11 1619887230005732 30/<strong>03</strong>/2<strong>01</strong>1 800/178/2<strong>01</strong>1 Setda Pemkot Langsa 12/05/11 22/09/11 16198873200<strong>03</strong>733 30/<strong>03</strong>/2<strong>01</strong>1 245/BPMPP/I/III/2<strong>01</strong>1Badan Pemberdayaan Masyarakat dan PemberdayaanPerempuan Pemprov Jambi10/06/11 23/09/11 1611498000008734 30/<strong>03</strong>/2<strong>01</strong>1 893.3/217.29 BKD Pemkab Karanganyar 10/06/11 30/09/11 1619887750008735 30/<strong>03</strong>/2<strong>01</strong>1 613/BPSDMKP.<strong>01</strong>/TU.210/III/2<strong>01</strong>1Badan Pengembangan SDM Kelautan dan PerikananKementerian KP10/06/11 16/09/11 1619886920006736 30/<strong>03</strong>/2<strong>01</strong>1 050/541/05/2<strong>01</strong>1 Setda Pemkab Magelang 10/06/11 30/09/11 1619887810009737 31/<strong>03</strong>/2<strong>01</strong>1 2<strong>01</strong>/PPPK/TU.110/III/2<strong>01</strong>1Kepala Pelabuhan Perikanan Nusantara KarangantuDirjend Perikanan Tangkap Kementerian Kelautan danPerikanan10/06/11 15/09/11 1619886670000738 31/<strong>03</strong>/2<strong>01</strong>1 .../DPU/III/2<strong>01</strong>1Kepala Dinas Pekerjaan Umum Pemkab KutaiKartanegara10/06/11 18/08/11 16198845900<strong>03</strong>739 31/<strong>03</strong>/2<strong>01</strong>1 600/89/III.<strong>03</strong>/PU/PSW/2<strong>01</strong>1 Dinas Pekerjaan Umum Pemkab Pesawaran 10/06/11 12/07/11 1611498230009740 31/<strong>03</strong>/2<strong>01</strong>1 600/135/III/Minbang-LK/2<strong>01</strong>1 Setda Pemkab Limapuluhkota 31/05/11 16/09/11 1619886810000741 31/<strong>03</strong>/2<strong>01</strong>1 942/531-100.5/III/2<strong>01</strong>1 Kepala Biro Umum Badan Pertanahan Nasional 10/06/11 16/09/11 1619886750009742 31/<strong>03</strong>/2<strong>01</strong>1 594.3/409/Set Bupati Maros 10/06/11 16/09/11 1619886690008743 31/<strong>03</strong>/2<strong>01</strong>1 050/0216/2<strong>01</strong>1 Setda Pemkab Wonosobo 10/06/11 15/09/11 1619886720002Hal 35

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>744 31/<strong>03</strong>/2<strong>01</strong>1 - Dinas Pendidikan Pemkot Depok 10/06/11 16/09/11 16114980700<strong>01</strong>745 31/<strong>03</strong>/2<strong>01</strong>1 -746 31/<strong>03</strong>/2<strong>01</strong>1 176/895.2/BPMPD/III/2<strong>01</strong>1747 31/<strong>03</strong>/2<strong>01</strong>1 151/DIR-MRT/III/2<strong>01</strong>1748 31/<strong>03</strong>/2<strong>01</strong>1 800/578/BKD.Sekr/2<strong>01</strong>1749 31/<strong>03</strong>/2<strong>01</strong>1 510.1/4026/021/2<strong>01</strong>1Sekretaris DPRD Kabupaten Minahasa TenggaraSekretariat DPRD Pemkab Minahasa TenggaraKepala Badan Penanaman Modal dan Promosi DaerahKabupaten Kutai KartanegaraDirektur Fungsi Korporasi dan Perencanaan PT. MassRapid Transit JakartaKepala Badan Kepegawaian Daerah Pemprov SumateraSelatanKepala Biro Administrasi Perekonomian SekretariatDaerah Pemprov Jawa Timur23/05/11 18/08/11 161988456000623/05/11 19/08/11 161988477000923/05/11 19/08/11 161988474000223/05/11 18/08/11 161988463000610/06/11 16/09/11 1619886830008750 31/<strong>03</strong>/2<strong>01</strong>1 600/Pemb/148 Setda Pemkab Bintan 23/05/11 19/08/11 16198846600<strong>03</strong>751 31/<strong>03</strong>/2<strong>01</strong>1 893.8/160/UmKepala Badan Koordinasi Pemerintahan danPembangunan Wilayah I Pemprov Jawa Barat10/06/11 30/09/11 1619888520006752 31/<strong>03</strong>/2<strong>01</strong>1 800/00817 Sekretaris Daerah Pemerintah Kabupaten Temanggung 10/06/11 18/08/11 1619884600009753 <strong>01</strong>/04/2<strong>01</strong>1 337/DCKTK-KS/A/III/2<strong>01</strong>1754 <strong>01</strong>/04/2<strong>01</strong>1 1270/-077.9Kepala Dinas Cipta Karya Dan Tata Kota PemkotSamarindaKepala Dinas Pemadaman Kebakaran danPenanggulangan Bencana Pemprov DKI Jakarta10/06/11 20/09/11 161988720000807/07/11 24/08/11 1619883910000755 <strong>01</strong>/04/2<strong>01</strong>1 1185/-1.851.7Kepala Suku Dinas Pendidikan Menengah PemkotAdministrasi Jakarta Selatan23/05/11 04/10/11 16198878800<strong>027</strong>56 <strong>01</strong>/04/2<strong>01</strong>1 <strong>027</strong>/<strong>01</strong>06Kepala Badan Pelaksana Penyuluhan dan KetahananPangan Pemkab Gunungkidul23/05/11 16/09/11 16198868900<strong>027</strong>57 <strong>01</strong>/04/2<strong>01</strong>1 136/Sesprov-006/III/2<strong>01</strong>1Sekretaris Komisi Pemilihan Umum Provinsi SumateraSelatanPersyaratan tidak lengkap758 <strong>01</strong>/04/2<strong>01</strong>1 S-382/WPJ.18/BG.<strong>01</strong><strong>01</strong>/2<strong>01</strong>1Kepala Kantor Wilayah Dirjend Pajak Papua danMaluku Kementerian KeuanganPersyaratan tidak lengkap759 <strong>01</strong>/04/2<strong>01</strong>1 098/H19.2/PL/2<strong>01</strong>1760 <strong>01</strong>/04/2<strong>01</strong>1 800/0462/Peg-BU/2<strong>01</strong>1(<strong>027</strong>/0463/BU/2<strong>01</strong>1)761 <strong>01</strong>/04/2<strong>01</strong>1 <strong>027</strong>/<strong>01</strong>58-TU/RSJ/2<strong>01</strong>1Ketua Lembaga Penelitian Universitas RiauKementerian Pendidikan NasionalSekretaris Daerah Pemkab Kotawaringin TimurDirektur Rumah Sakit Khusus Daerah Sambang LihumProvinsi Kalimantan Selatan31/05/11 16/09/11 161988685000623/05/11 16/09/11 1619886910007Sudah lulus ujian762 <strong>01</strong>/04/2<strong>01</strong>1 800/413/414.1<strong>03</strong>/2<strong>01</strong>1 Sekretaris Daerah Pemkab Tuban 08/06/11 20/09/11 16198871800<strong>03</strong>763 <strong>01</strong>/04/2<strong>01</strong>1 <strong>027</strong>/578/Set Sekretaris Daerah Pemkab Wajo 15/08/11 20/09/11 1619887210007Hal 36

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>764 04/04/2<strong>01</strong>1 <strong>027</strong>/405/Admbang Sekretaris Daerah Pemkab Garut 31/05/11 15/09/11 1619886630004765 04/04/2<strong>01</strong>1 <strong>027</strong>/230/W4BUP/2<strong>01</strong>1 Wakil Bupati Kabupaten Fakfak <strong>01</strong>/08/11 18/08/11 1619884570005766 04/04/2<strong>01</strong>1 <strong>027</strong>/183/SET/2<strong>01</strong>1 Sekretaris Daerah Pemkab Fakfak Persyaratan tidak lengkap767 04/04/2<strong>01</strong>1 020/1107/132 Sekretaris Daerah Pemkot Magelang <strong>01</strong>/08/11 12/09/11 16198863400<strong>027</strong>68 04/04/2<strong>01</strong>1 - an Amir Hasan (setda Kota Medan) 12/05/11 18/08/11 1619884540008769 04/04/2<strong>01</strong>1 890/422/II.10/TF/2<strong>01</strong>1Kepala Badan Pendidikan dan Latihan DaerahPemprov Lampung31/05/11 22/09/11 1619887460006770 04/04/2<strong>01</strong>1 B/816/III/2<strong>01</strong>1 Direktur Kesehatan Angkatan Darat MABES AD 31/05/11 12/09/11 1619886430000771 04/04/2<strong>01</strong>1 <strong>027</strong>/059/KORPRI/2<strong>01</strong>1772 04/04/2<strong>01</strong>1 518/4/197Sekretaris Dewan Pengurus KORPRI ProvinsiSumatera SelatanKepala Dinas Koperasi, Usaha Mikro, Kecil danMenengah Provinsi Maluku08/06/11 04/10/11 1619889200006Persyaratan tidak lengkap773 04/04/2<strong>01</strong>1 500.A3/138/AP/III/2<strong>01</strong>1 Sekretaris Daerah Pemkab Agam <strong>01</strong>/06/11 12/09/11 1619886390007774 04/04/2<strong>01</strong>1 800/561/BKD/2<strong>01</strong>1775 04/04/2<strong>01</strong>1 S-163/PU.1/2<strong>01</strong>1776 04/04/2<strong>01</strong>1 376.1/PL.200/J.3.9/<strong>03</strong>/2<strong>01</strong>1777 04/04/2<strong>01</strong>1 800/513/416-115/2<strong>01</strong>1Kepala Badan Kepegawaian dan Diklat Daerah Kab.Ogan IlirSekretaris Direktorat Jenderal Pengelolaan UtangKementerian KeuanganKepala Balai Pelatihan Pertanian Jambi BadanPenyuluh dan Pengembangan SDM PertanianKementerian PertanianKepala Dinas Pendapatan dan Pengelolaan Keuangandan Set Pemkab Mojokerto23/05/11 12/09/11 1619886310005<strong>01</strong>/06/11 12/09/11 16198864200<strong>01</strong>08/06/11 12/09/11 161988629000023/05/11 12/09/11 1619886450008778 04/04/2<strong>01</strong>1 198/-077 Kepala P3PNFI Provinsi DKI Jakarta Persyaratan tidak lengkap779 04/04/2<strong>01</strong>1 041/0023/Artha Bhakti/III/2<strong>01</strong>1 Direktur Yayasan Artha Bhakti 31/05/11 19/08/11 16198847500<strong>01</strong>780 04/04/2<strong>01</strong>1 DJ/III/KS.<strong>01</strong>.7/259/2<strong>01</strong>1Direktur Jenderal Bimbingan Masyarakat KristenKementerian Agama08/06/11 12/09/11 1619886440009781 04/04/2<strong>01</strong>1 640/123/Kes/II/2<strong>01</strong>1 Kepala Dinas Kesehatan Pemkab Musi Banyuasin <strong>01</strong>/06/11 12/09/11 16198864100<strong>027</strong>82 04/04/2<strong>01</strong>1 893.3/976/2<strong>01</strong>1 Sekretaris Daerah Pemkab Kebumen 31/05/11 12/09/11 1619886370009783 04/04/2<strong>01</strong>1 2352/LKI-K/2<strong>01</strong>1 Ketua Lembaga Kajian Indonesia 31/05/11 12/09/11 16198864000<strong>03</strong>784 04/04/2<strong>01</strong>1 933/A.Pemb-NGK/44/<strong>03</strong>/2<strong>01</strong>1 Bupati Negekeo 31/05/11 04/10/11 1619889140005Hal 37

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>785 04/04/2<strong>01</strong>1 <strong>01</strong>79/OT.220/L.27.C/3/11786 04/04/2<strong>01</strong>1 200/58/2<strong>01</strong>1787 04/04/2<strong>01</strong>1 260/057/2<strong>01</strong>1788 04/04/2<strong>01</strong>1 800/52/2<strong>01</strong>1Kepala Balai Karantina Pertanian Kelas IITanjungpinang Badan Karantina PertanianKementerian PertanianKepala Kantor Pelayanan Perizinan Terpadu PemkabAceh UtaraKepala Kantor Pemberdayaan Perempuan danPerlindungan Anak Pemkab Aceh UtaraKepala Dinas Pasar, Kebersihan dan PertamananPemkab Aceh Utara08/06/11 22/09/11 161988737000808/06/11 04/10/11 1619889220004Persyaratan tidak lengkapPersyaratan tidak lengkap789 04/04/2<strong>01</strong>1 810/EKBANG/286 Sekretaris Daerah Pemkab Kuantan Singingi 31/05/11 22/09/11 1619887380007790 05/04/2<strong>01</strong>1 04.<strong>01</strong>.25/PSDKP0.2.1/TU.210/IV/2<strong>01</strong>1791 05/04/2<strong>01</strong>1 392/J26/LL/2<strong>01</strong>1792 05/04/2<strong>01</strong>1 445/345/RSUD/2<strong>01</strong>1793 05/04/2<strong>01</strong>1 PH.344/1/1/UPP.Anl-11Sekretaris Dirjend Pengawasan Sumber Daya Kelautandan Perikanan Kementerian Kelautan dan PerikananKepala Lembaga Penjaminan Mutu PendidikanProvinsi Lampung Kemdiknaskanwil DJP Jakarta Selatan Dirjen Pajak KementerianKeuanganKepala Kantor Unit Penyelenggara Pelabuhan AnyerDirjend Perhubungan Laut Kementerian Perhubungan08/06/11 12/09/11 161988638000808/06/11 22/09/11 16198874100<strong>01</strong>10/06/11 12/09/11 16198863500<strong>01</strong>23/05/11 12/09/11 16198862800<strong>01</strong>794 05/04/2<strong>01</strong>1 77/084.25Kepala Suku Dinas Pekerjaan Umum KabupatenAdministrasi Kepulauan Seribu23/05/11 13/09/11 1611495810006795 05/04/2<strong>01</strong>1 800/191.8/I.06/2<strong>01</strong>1 Sekretaris Daerah Pemkab Pringsewu 05/08/11 12/09/11 1619886320004796 05/04/2<strong>01</strong>1 1281/H35/KU/2<strong>01</strong>1 Rektor Universitas Negeri Padang Kemdiknas 23/05/11 04/10/11 16198879400<strong>03</strong>797 05/04/2<strong>01</strong>1 600/SEKRT-86.b/DBMP/III/2<strong>01</strong>1798 05/04/2<strong>01</strong>1 331/-077Kepala Dinas Bina Marga dan Pengairan PemkotSamarindaSekretrais Kota Administrasi Jakarta Selatan, PemprovDKI Jakarta27/06/11 04/10/11 161988795000208/06/11 12/09/11 1611498880006799 05/04/2<strong>01</strong>1 078-B/H3.13/PPd/2<strong>01</strong>1Ketua Pelaksana Lembaga Penelitian dan PengabdianKepada Masyarakat Universitas AirlanggaPersyaratan tidak lengkap800 05/04/2<strong>01</strong>1 556/DISPORABUDPAR/78/III/2<strong>01</strong>18<strong>01</strong> 05/04/2<strong>01</strong>1 443/D.D2/LK/2<strong>01</strong>1802 05/04/2<strong>01</strong>1 422/Perindag/Set.2/III/2<strong>01</strong>1Kepala Dinas Pemuda, Olahraga, Kebudayaan danPariwisata Pemkab NatunaDirektur Jenderal Pendidikan Menengah KementerianPendidikan NasionalKepala Dinas Perindustrian dan Perdagangan PemprovSumatera Selatan23/05/11 18/08/11 1619884760000<strong>01</strong>/06/11 19/08/11 1619884690000<strong>01</strong>/06/11 18/08/11 1619884650004Hal 38

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>8<strong>03</strong> 05/04/2<strong>01</strong>1 Kw.15/1-a/OT.<strong>01</strong>.1/1557/2<strong>01</strong>1804 06/04/2<strong>01</strong>1 B.6321/BLKI-TU/IV/2<strong>01</strong>1805 06/04/2<strong>01</strong>1 KP.<strong>01</strong>.<strong>01</strong>/II.5/345/2<strong>01</strong>1Kepala Kantor Wilayah Kementerian Agama ProvinsiKalimantan TengahKepala Balai Latihan Kerja Industri Semarang DirjendPembinaan Pelatihan dan ProduktivitasKemenakertransDirektur Utama RSUP DR. M. Jamil Padang DirjendBina Pelayanan Medik Kementerian Kesehatan08/06/11 30/09/11 161988797000<strong>027</strong>/06/11 04/10/11 161988927000908/06/11 04/10/11 16198892500<strong>01</strong>806 06/04/2<strong>01</strong>1 W10-A1/1229/KP.<strong>01</strong>.2/III/2<strong>01</strong>1 Ketua Pengadilan Agama Bandung Kelas IA 08/06/11 04/10/11 1619889240002807 06/04/2<strong>01</strong>1 KN.376/<strong>01</strong>/10/OP.SBA.2<strong>01</strong>1Kepala Kantor Otoritas Pelabuhan III Tanjung PerakSurabaya Dirjend Perhubungan Laut KementerianPerhubunganPersyaratan tidak lengkap808 06/04/2<strong>01</strong>1 UM.<strong>01</strong>.<strong>03</strong>/BWS-Mal/I/07BKepala Balai Wilayah Sungai Maluku Dirjend SumberDaya Air Kementerian PU31/05/11 04/10/11 1619887980009809 06/04/2<strong>01</strong>1 909/Dishub/III/2<strong>01</strong>1 Kepala Dinas Perhubungan Kab. Kutai Kartanegara Persyaratan tidak lengkap810 06/04/2<strong>01</strong>1 Kd.21.06/OT.<strong>01</strong>.3/1082/2<strong>01</strong>1 Kepala Kantor Kementerian Agama Kab. Tana Toraja Persyaratan tidak lengkap811 06/04/2<strong>01</strong>1 <strong>03</strong>9/084.2812 06/04/2<strong>01</strong>1 61/-084.2813 06/04/2<strong>01</strong>1 800/149.2/BKD.IV/2<strong>01</strong>1Kepala Suku Dinas Komunikasi, Informatika dankehumasan kota Administrasi Jakarta TimurKepala Suku Dinas Perumahan dan Gedung PemdaKota Administrasi Jakarta SelatanKepala Badan Kepegawaian dan Diklat Kab. OganKomering ulu Selatan08/06/11 04/10/11 161988907000508/06/11 04/10/11 16198892300<strong>03</strong>08/06/11 04/10/11 1619889260000814 06/04/2<strong>01</strong>1 500/094/IV/Ekbang/2<strong>01</strong>1 Bupati Luwu Timur 31/05/11 04/10/11 16198878900<strong>01</strong>815 06/04/2<strong>01</strong>1 893.3/296/405.02.2/2<strong>01</strong>1 Sekretaris Daerah Pemkab Ponorogo 31/05/11 04/10/11 1619887830007816 06/04/2<strong>01</strong>1 029/331-Umum817 06/04/2<strong>01</strong>1 Kw.02/1-c/KU.00/806.A/2<strong>01</strong>1818 06/04/2<strong>01</strong>1 W1-DL.<strong>03</strong>.<strong>01</strong>-52819 06/04/2<strong>01</strong>1 W6.PR.<strong>01</strong>.04-646Kepala Dinas Pertanian dan Peternakan PemkabIndramayuKepala Bagian Tata Usaha Provinsi Sumatera UtaraKementerian AgamaKepala Kantor Wilayah Aceh Kementerian Hukum danHAMKepala Kantor Wilayah Lampung Kementerian Hukumdan HAM RI<strong>01</strong>/06/11 04/10/11 161988908000408/06/11 04/10/11 1619889210005<strong>01</strong>/06/11 04/10/11 161988913000608/06/11 04/10/11 1619889190000Hal 39

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>820 06/04/2<strong>01</strong>1 316/Irbanwil III/2<strong>01</strong>1 Inspektur Provinsi Jambi Pemprov Jambi 08/06/11 04/10/11 16198890900<strong>03</strong>821 07/04/2<strong>01</strong>1 <strong>027</strong>/24 Dinas PU Pemprov MAluku <strong>01</strong>/06/11 30/09/11 1619887930004822 07/04/2<strong>01</strong>1 S.1<strong>01</strong>6/IV-K.10/2<strong>01</strong>1823 07/04/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/1.1/0709.1/2<strong>01</strong>1824 07/04/2<strong>01</strong>1 PL.05.<strong>01</strong>/A.5.3/042/2<strong>01</strong>1Kepala Balai Konservasi Sumber Daya Alam DKIJakarta Dirjend Perlindungan Hutan dan KonservasiAlam Kementerian KehutananDirektur Politeknik Kesehatan Bandung KementerianKesehatanDirektur Politeknik Kesehatan Semarang KementerianKesehatan<strong>01</strong>/06/11 30/09/11 1619888500008<strong>01</strong>/06/11 04/10/11 1619888980008<strong>01</strong>/06/11 04/10/11 16198891600<strong>03</strong>825 07/04/2<strong>01</strong>1 <strong>027</strong>/232/PEMBSDA/IV/2<strong>01</strong>1 Sekretaris Daerah Kota Pemkot Pangkal Pinang <strong>01</strong>/06/11 30/09/11 16198879600<strong>01</strong>826 08/04/2<strong>01</strong>1 893.3/323 Kepala Badan Kepegawaian Daerah Pemkab Semarang <strong>01</strong>/06/11 04/10/11 1619889020000827 08/04/2<strong>01</strong>1 DL.107/7/3/Ro.3/KKP/2<strong>01</strong>1828 08/04/2<strong>01</strong>1 410/2-35.73/III/2<strong>01</strong>1Sekretaris Jenderal Kementerian Kebudayaan danPariwisataKepala Kantor Pertanahan Kota Malang Provinsi JawaTimur, Badan Pertanahan Nasional<strong>01</strong>/06/11 04/10/11 1619887420000<strong>01</strong>/06/11 04/10/11 1619887450007829 08/04/2<strong>01</strong>1 525/428/IV/Disbun/2<strong>01</strong>1 Kepala Dinas Perkebunan Pemprov. Sulawesi Barat <strong>01</strong>/06/11 04/10/11 1619888<strong>01</strong>0002830 08/04/2<strong>01</strong>1 800/286/Adm.Pemb-2<strong>01</strong>1 Bupati Sijunjung <strong>01</strong>/06/11 05/10/11 1619888740008831 08/04/2<strong>01</strong>1 -832 08/04/2<strong>01</strong>1 172/-1.857833 08/04/2<strong>01</strong>1 800/0648834 08/04/2<strong>01</strong>1 UK.112/<strong>03</strong>/12/AD.Mdo-11835 08/04/2<strong>01</strong>1 S.140/BUHT-5/2<strong>01</strong>1836 11/04/2<strong>01</strong>1 621/FTP-UGM/LK/2<strong>01</strong>1Kepala Dinas Penataan dan Pengawasan BangunanPemkot BekasiKepala Suku Dinas Olahraga dan Pemuda JakartaSelatan, Dinas Olah Raga dan Pemuda Pemprov DKIJakartaKepala Dinas Pendidikan, Pemuda, dan OlahragaPemkab GunungkidulKepala Kantor Administrator Pelabuhan ManadoDirjend Perhubungan Laut Kementerian PerhubunganSekretaris Direktorat Jenderal Bina Usaha KehutananKementerian KehutananDekan Fakultas Teknologi Pertanian UniversitasGadjah Mada<strong>01</strong>/06/11 30/09/11 16198885500<strong>03</strong><strong>01</strong>/06/11 04/10/11 1619885230007<strong>01</strong>/06/11 05/10/11 16198886400<strong>01</strong><strong>01</strong>/06/11 05/10/11 1619888730009<strong>01</strong>/06/11 04/10/11 161988751000808/06/11 04/10/11 1619887470005Hal 40

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>837 11/04/2<strong>01</strong>1 061/UN33.9/PM/2<strong>01</strong>1 Ketua LPKM Universitas Negeri Medan Kemdiknas 31/05/11 19/07/11 1619880920002838 11/04/2<strong>01</strong>1 050.13/432 Kepala Bappeda Pemkab Asahan <strong>01</strong>/06/11 04/10/11 1619888560002839 11/04/2<strong>01</strong>1 188.45/124/PUSDMKepala Dinas Pekerjaan Umum dan Sumber DayaMineral Pemkab Poso<strong>01</strong>/06/11 30/09/11 1619888470004840 11/04/2<strong>01</strong>1 0<strong>01</strong>/<strong>01</strong>5/Pemb/2<strong>01</strong>1Kepala Bagian Pembangunan Sekretariat Daerah Kab.Hulu Sungai Tengah841 11/04/2<strong>01</strong>1 02/BM-KSK/2<strong>01</strong>1Kabid Binamarga Dinas Pekerjaan Umum PemkabMimika<strong>01</strong>/06/11 05/10/11 1619888910005842 11/04/2<strong>01</strong>1 800/621/60/2<strong>01</strong>1 Direktur RS Daerah dr. Soebandi Pemkab Jember <strong>01</strong>/06/11 04/10/11 1619888590009843 11/04/2<strong>01</strong>1 470/071/Dukcapil/2<strong>01</strong>1844 11/04/2<strong>01</strong>1 S-193/WPJ.31/KP.<strong>01</strong><strong>01</strong>/2<strong>01</strong>1Kepala Dinas Kependudukan dan Pencatatan SipilPemkab TeboKepala KPP Pratama Mataram Barat Kanwil DJP NusaTenggara Dirjend Pajak Kementerian Keuangan<strong>01</strong>/06/11 05/10/11 1619888690006<strong>01</strong>/06/11 05/10/11 1619888810008Persyaratan tidak lengkap845 11/04/2<strong>01</strong>1 187/-084.2 Sekretaris DPRD Prov. DKI Jakarta 08/06/11 05/10/11 1619888700002846 11/04/2<strong>01</strong>1 800/737/Sekre/2<strong>01</strong>1 Kepala Dinas Pendidikan Pemprov Jambi Persyaratan tidak lengkap847 11/04/2<strong>01</strong>1 128/07.3Camat Jagakarsa Pemkot Administrasi Jakarta SelatanPemprv. DKI Jakarta<strong>01</strong>/06/11 05/10/11 1619888670008848 11/04/2<strong>01</strong>1 800/115/IV/Sekwan/2<strong>01</strong>1 Sekretaris DPRD Pemkab Muaro Jambi <strong>01</strong>/06/11 04/10/11 1619887530006849 11/04/2<strong>01</strong>1 KP308/SU/BMKG-2<strong>01</strong>1 Badan Meteorologi Klimatologi dan Geofisika 08/06/11 04/10/11 1619885250005850 11/04/2<strong>01</strong>1 800/1057/RSUKeapla Bagian Perencanaan dan Rekam Medis RSUBanjar Pemkot Banjar<strong>01</strong>/06/11 05/10/11 1619888660009851 12/04/2<strong>01</strong>1 050/705 Sekretaris Daerah Pemkab Merauke 08/06/11 30/09/11 1619888540004852 12/04/2<strong>01</strong>1 <strong>027</strong>/158-Pemb Sekretaris Daerah Pemkab Bogor <strong>01</strong>/06/11 04/10/11 16198874900<strong>03</strong>853 12/04/2<strong>01</strong>1 800/140/IV/PU/2<strong>01</strong>1 Kepala Dinas PU Pemkab Muaro Jambi <strong>01</strong>/06/11 04/10/11 1619887820008854 12/04/2<strong>01</strong>1 W5-A/532/Kp.<strong>01</strong>.1/IV/2<strong>01</strong>1 Ketua Pengadilan Tinggi Agama Jambi Persyaratan tidak lengkap855 12/04/2<strong>01</strong>1 028/02232/04/2<strong>01</strong>1 Sekretaris Daerah Pemkab Boyolali 08/06/11 15/09/11 16198866600<strong>01</strong>856 12/04/2<strong>01</strong>1 890/441/APBupati Aceh Tengah Sekretariat Daerah KabupatenPemkab Aceh Tengah10/06/11 04/10/11 1619887480004857 12/04/2<strong>01</strong>1 045.4/121/I.3/Litb/2<strong>01</strong>1Kepala Badan Penelitian dan Pengembangan DaerahPemprov. Kalimantan TimurSudah lulus ujianHal 41

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>858 12/04/2<strong>01</strong>1 659/DAGLU,4-3/IV/2<strong>01</strong>1859 12/04/2<strong>01</strong>1 21/PL3/LL/2<strong>01</strong>1860 12/04/2<strong>01</strong>1 800/BM-SDA/2<strong>01</strong>1/154Direktur Impor Direktorat Jenderal Perdagangan LuarNegeri Kementerian PerdaganganDirektur Politeknik Negeri Jakarta KementerianPendidikan NasionalKepala Dinas Bina Marga Sumber Daya Air PemkabPelalawan25/08/11 04/10/11 16198885700<strong>01</strong>10/06/11 15/09/11 161988677000710/06/11 05/10/11 16198887100<strong>01</strong>861 12/04/2<strong>01</strong>1 132/J.J44/LL/2<strong>01</strong>1 Kepala LPMP Prov. Gorontalo Kemendiknas 08/06/11 05/10/11 1619888720000862 12/04/2<strong>01</strong>1 800/784/35.73.306/2<strong>01</strong>1 Kepala Dinas Kesehatan Pemkot Malang 08/06/11 04/10/11 16198889500<strong>01</strong>863 12/04/2<strong>01</strong>1 W3-A4/515/KU.05/IV/2<strong>01</strong>1Panitera/Sekretrais Pengadilan Agama BukittinggiKelas IB Selaku Kuasa Pengguna Anggaran864 12/04/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/34/III/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemprov NTT 27/06/11 22/09/11 1619887350000Persyaratan tidak lengkap865 12/04/2<strong>01</strong>1 873/700/DBM Kepala Dinas Bina Marga Pemprov Sulawesi Selatan 08/06/11 04/10/11 16198891800<strong>01</strong>866 12/04/2<strong>01</strong>1 893.3/9<strong>01</strong>/411.3<strong>03</strong>/2<strong>01</strong>1 Kepala Badan Kepegawaian Daerah Pemkab Nganjuk 27/06/11 22/09/11 1619887390006867 12/04/2<strong>01</strong>1 600/451/Bangda/2<strong>01</strong>1 Sekretaris Daerah Pemkab Tanah Laut 10/06/11 04/10/11 1619889<strong>01</strong>00<strong>01</strong>868 12/04/2<strong>01</strong>1 440/1997-umum Dinas Kesehatan Pemkot Depok 08/06/11 04/10/11 1619888960000869 12/04/2<strong>01</strong>1 800.05/1025/DPU Kepala Dinas Pekerjaan Umum Pemprov. Bali 08/06/11 04/10/11 1619888580000870 12/04/2<strong>01</strong>1 800/352/11-LU/2<strong>01</strong>1 Kepala Dinas Pendidikan Pemkab Lampung Utara 08/06/11 04/10/11 1619888970009871 12/04/2<strong>01</strong>1 893.3/264/BKD Kepala Badan Kepegawaian Pemkab Klungkung 10/06/11 05/10/11 1619888830006872 13/04/2<strong>01</strong>1 2353/LKI/IV/2<strong>01</strong>1 Lembaga Kajian Indonesia - Pekanbaru 25/08/11 06/10/11 1619887390006873 13/04/2<strong>01</strong>1 800/064.20/S.2/IV/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkot Balikpapan 26/08/11 22/09/11 1619887360009874 Kepala Dinas Pekerjaan Umum Pemkot Balikpapan 26/08/11 22/09/11 1619887360009875 13/04/2<strong>01</strong>1 127/B.5/A.3/2<strong>01</strong>1Kepala Biro Umum Badan Koordinasi PenanamanModal10/06/11 15/09/11 1619886680009876 13/04/2<strong>01</strong>1 005/152/Dishubkominfo/IV/2<strong>01</strong>1Kepala Dinas Perhubungan, Komunikasi danInformatika Pemkab Murung Raya08/06/11 04/10/11 1619888600005877 13/04/2<strong>01</strong>1 <strong>027</strong>/I/00<strong>03</strong>14/PendaKepala Dinas Pendapatan Daerah Pemprov SumateraSelatan08/06/11 04/10/11 1619887500009878 13/04/2<strong>01</strong>1 9<strong>03</strong>/613Dinas Sosial Tenaga Kerja dan Transmigrasi PemkabBrebes08/06/11 04/10/11 1619885220008879 13/04/2<strong>01</strong>1 <strong>027</strong>/110/SW/2<strong>01</strong>1 Sekretaris DPRD Kabupaten Serdang Bedagai 08/06/11 05/10/11 1611498720005Hal 42

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>880 13/04/2<strong>01</strong>1 PL.02.06-Ks/172881 13/04/2<strong>01</strong>1 PL.<strong>01</strong>.02/IV.H.1/4004/2<strong>01</strong>1Sekretaris Badan Pembinaan Konstruksi KementerianPUDirektur Utama RSUP Sanglah Denpasar Dirjend BinaUpaya Kesehatan Kementerian Kesehatan27/06/11 06/10/11 161640859000628/06/11 04/10/11 1619888610004882 14/04/2<strong>01</strong>1 <strong>027</strong>/366/437.75/2<strong>01</strong>1 Kepala Badan Lingkungan Hidup Pemkab Gresik 27/06/11 05/10/11 1619888920004883 14/04/2<strong>01</strong>1 36<strong>01</strong>/H25/TU.8/2<strong>01</strong>1 Rektor Universitas Jember 10/06/11 05/10/11 1619888770005884 14/04/2<strong>01</strong>1 - an I Putu Wedha Astawa Sertifikat Masih Berlaku885 14/04/2<strong>01</strong>1 Kd.16.12/I/KP.0<strong>03</strong>/284/2<strong>01</strong>1 Kantor Kabupaten Bulungan Kementerian Agama Persyaratan tidak lengkap886 14/04/2<strong>01</strong>1 <strong>027</strong>/55 Kepala Dinas Pekerjaan Umum Pemprov Maluku 08/06/11 05/10/11 1619888850004887 14/04/2<strong>01</strong>1 045.2/2348 Sekretaris Daerah Pemkab Wonogiri 10/06/11 05/10/11 16198897800<strong>03</strong>888 14/04/2<strong>01</strong>1 <strong>027</strong>/1408/404.1.2.2/2<strong>01</strong>1 Sekretaris Daerah Pemkab Sidoarjo 10/06/11 04/10/11 1619885200000889 14/04/2<strong>01</strong>1 <strong>027</strong>/532.a/PP Bupati Indramayu 10/06/11 05/10/11 1611498340005890 14/04/2<strong>01</strong>1 800/131/RSUD/2<strong>01</strong>1 Direktur RSUD Kabupaten Muaro Jambi 10/06/11 04/10/11 1619889170002891 14/04/2<strong>01</strong>1 912/123-Admpemb/2<strong>01</strong>1 Sekretaris Daerah Pemkab Lebak 10/06/11 05/10/11 1619888650000892 14/04/2<strong>01</strong>1 2126/UN32.17/KP/2<strong>01</strong>1 Kepala BiroAUK Universitas Negeri Malang 27/06/11 05/10/11 1619889100009893 14/04/2<strong>01</strong>1 73/PEMB-SDA/IV/2<strong>01</strong>1 Sekretaris Daerah Pemkab Karimun 27/06/11 06/10/11 1619889360007894 15/04/2<strong>01</strong>1 050/119/Bapp-I/III/2<strong>01</strong>1 Kepala Bappeda Kabupaten Berau 10/06/11 05/10/11 1619889110008895 15/04/2<strong>01</strong>1 KN.372/<strong>01</strong>/12/OP.SBA.2<strong>01</strong>1Kepala Kantor Otoritas Pelabuhan III Tanjung PerakSurabaya Dirjend Perhubungan Laut10/06/11 05/10/11 1619888890000896 15/04/2<strong>01</strong>1 KW.13.1/5/Ks.<strong>01</strong>.7/1173/2<strong>01</strong>1 Kepala Kantor Wilayah Provinsi Jawa Timur 10/06/11 05/10/11 1619889050007897 15/04/2<strong>01</strong>1 0089/BII.SESKEMENPORA/4/2<strong>01</strong>1 Sekretaris Kementerian Pemuda dan Olahraga 10/06/11 05/10/11 1619889310002898 15/04/2<strong>01</strong>1 926/-083.6.2899 15/04/2<strong>01</strong>1 008/<strong>03</strong>1900 15/04/2<strong>01</strong>1 <strong>027</strong>/223/I/Dislutkan/2<strong>01</strong>1Kepala Dinas Perumahan dan Gedung Pemda Prov.DKI jakartaKepala Dinas Pekerjaan Umum, Pertambangan danPerhubungan Kabupaten SupioriKepala Dinas Kelautan dan Perikanan ProvinsiSumatera Selatan27/06/11 05/10/11 161988882000710/06/11 05/10/11 1619889290007Persyaratan tidak lengkapHal 43

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>9<strong>01</strong> 15/04/2<strong>01</strong>1 800/055/D.09/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkab Pringsewu 28/06/11 05/10/11 1619888990007902 15/04/2<strong>01</strong>1 045.2/159/IV/2<strong>01</strong>19<strong>03</strong> 15/04/2<strong>01</strong>1 048/330/UIPKITRINGKAL/2<strong>01</strong>1904 15/04/2<strong>01</strong>1 Kd.02.22/I/HM.00.1/511/2<strong>01</strong>1Kepala Biro Pembangunan Setda Prov. Kep.BangkaBelitungGeneral Manager PT. PLN Unit Induk PembangunanPembangkit dan Jaringan KalimantanKepala Kantor Kabupaten Serdang BedagaiKementerian Agama24/06/11 05/10/11 161988933000<strong>01</strong>0/06/11 05/10/11 16114982100<strong>01</strong>10/06/11 05/10/11 1619888750007905 15/04/2<strong>01</strong>1 2176/TU-2/050/<strong>03</strong>-2<strong>01</strong>1 Kepala Dinas Kesehatan Pemkab Kapuas 10/06/11 05/10/11 1619888780004906 15/04/2<strong>01</strong>1 <strong>027</strong>/382/Balitbangda.Sekr/2<strong>01</strong>1Kepala Badan Penelitian dan Pengembangan DaerahPemprov. Sumatera Selatan27/06/11 05/10/11 16198887900<strong>03</strong>907 15/04/2<strong>01</strong>1 800/714/TU.U Plh. Kepala Dinas Kesehatan Pemkab Gunungkidul 27/06/11 05/10/11 1619888900006908 15/04/2<strong>01</strong>1 045.21/214.A/DPU/IV/2<strong>01</strong>1909 15/04/2<strong>01</strong>1 523.<strong>027</strong>/493/SEK910 15/04/2<strong>01</strong>1 410/386/Pemb/2<strong>01</strong>1911 18/04/2<strong>01</strong>1 18.24/523.3/758/2<strong>01</strong>1Kepala Dinas Pekerjaan Umum Pemkab KotawaringinTimurKepala Dinas Kelautan dan Perikanan Pemprov.Sulawesi TengahSekretaris Daerah Kabupaten Pemkab HumbangHasundutanKepala Dinas Perikanan dan Kelautan Pemkab SerdangBedagai10/06/11 05/10/11 16198888600<strong>03</strong>10/06/11 06/10/11 16198900500<strong>03</strong>27/06/11 06/10/11 161988968000628/06/11 05/10/11 16198893000<strong>03</strong>912 18/04/2<strong>01</strong>1 810/60/KKP-TU Kepala Kantor Ketahanan Pangan Kabupaten Sanggau 28/06/11 06/10/11 1619889750006913 18/04/2<strong>01</strong>1 <strong>027</strong>/1658-TU/RSASDirektur RSUD Dr.H.Moch Ansari Saleh Pemprov.Kalimantan Selatan27/06/11 05/10/11 16198889300<strong>03</strong>914 18/04/2<strong>01</strong>1 440/916/4<strong>01</strong>.1<strong>03</strong>/2<strong>01</strong>1 Kepala Dinas Kesehatan Pemkot Madiun 28/06/11 06/10/11 1619889760005915 18/04/2<strong>01</strong>1 B.07.<strong>01</strong>/BBAT.MDG/PL.610/IV/2<strong>01</strong>1Kepala Balai Budidaya Air Tawar Mandangin DirjendPerikanan Budidaya Kementerian Kelautan danPerikananPersyaratan tidak lengkap916 18/04/2<strong>01</strong>1 250/II/B.5/2<strong>01</strong>1 Sekretaris Daerah Pemkab Bengkulu Utara 27/06/11 06/10/11 1619889640000917 18/04/2<strong>01</strong>1 B/578/IV/2<strong>01</strong>1 Kepala Kepolisian Daerah Maluku 27/06/11 05/10/11 16198886200<strong>03</strong>Hal 44

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>918 18/04/2<strong>01</strong>1 Kd.12.2/1/715/2<strong>01</strong>1 Kepala Kantor Kabupaten Bantul Kementerian Agama 28/06/11 05/10/11 1619889710000919 18/04/2<strong>01</strong>1 890/02/PU BM/2<strong>01</strong>1 Kepala Dinas PU Bina Marga Pemkab Banyuasin 27/06/11 05/10/11 1619888940002920 18/04/2<strong>01</strong>1 1711/UN26/KU/2<strong>01</strong>1 Rektor Universitas Lampung 28/06/11 05/10/11 16198888800<strong>01</strong>921 18/04/2<strong>01</strong>1 900/78/BPMPDK/2<strong>01</strong>1Kepala Badan Pemberdayaan Masyarakat PemerintahDesa/KelurahanPersyaratan tidak lengkap922 18/04/2<strong>01</strong>1 UK.110/92/22/DNG.MKS-II923 18/04/2<strong>01</strong>1 600/31/IV/2<strong>01</strong>1Kepala Distrik Navigasi Kelas I Makassar DirjendPerhubungan Laut Kementerian PerhubunganPlt. Kepala Dinas Pekerjaan Umum Pemkab SeramBagian Timur28/06/11 05/10/11 16198893200<strong>01</strong>28/06/11 05/10/11 1619889720009924 18/04/2<strong>01</strong>1 640/108/DCK/2<strong>01</strong>1 Kepala Dinas Cipta Karya Pemkab Aceh Utara 27/06/11 06/10/11 1619889450005925 18/04/2<strong>01</strong>1 B.761/SJ.3/TU.210/IV/2<strong>01</strong>1Kepala Biro Keuangan Sekjend Kementerian Kelautandan Perikanan<strong>01</strong>/08/11 05/10/11 1619889280008926 18/04/2<strong>01</strong>1 893.3/99/407.022/2<strong>01</strong>1 Sekretaris Daerah Pemkab Tulungagung 27/06/11 06/10/11 1619889430007927 18/04/2<strong>01</strong>1 600/09/D.1/2<strong>01</strong>1 Setda Pemkot Metro 05/05/11 14/06/11 1611498440002928 18/04/2<strong>01</strong>1 Un.04/R/KP.02.3/0974/2<strong>01</strong>1 Rektor UIN Sultan Syarif Kasim Riau 27/06/11 05/10/11 1619889730008929 18/04/2<strong>01</strong>1 B-657/KP3K.0/IV/2<strong>01</strong>1Sekretaris Direktorat Jenderal Kelautan, Pesisir danPulau-pulau Kecil Kementerian Kelautan danPerikananSertifikat Masih Berlaku930 19/04/2<strong>01</strong>1 <strong>027</strong>/352/6 Kepala Dinas Perkebunan Pemprop Bengkulu 28/06/11 06/10/11 16198897000<strong>01</strong>931 19/04/2<strong>01</strong>1 050/Dikpora-SP/756932 19/04/2<strong>01</strong>1 600/446/PU/2<strong>01</strong>1933 19/04/2<strong>01</strong>1 S-352/BL.<strong>01</strong>/UP.6/2<strong>01</strong>1934 19/04/2<strong>01</strong>1 800/134.a/BBPH/IV/2<strong>01</strong>1Kepala Dinas Pendidikan Pemuda dan OlahragaPemkab KamparPlt. Kepala Dinas Pekerjaan Umum PemkabMandailing NatalSekretaris Badan Pengawas Modal dan LembagaKeuangan Kementerian KeuanganKepala Balai Benih Tanaman Pangan dan HortikulturaDinas Pertanian Tanaman Pangan dan HortikulturaPemprov Kalimantan Selatan28/06/11 04/10/11 161988752000727/06/11 05/10/11 161988868000728/06/11 05/10/11 1619889120007Persyaratan tidak lengkap935 19/04/2<strong>01</strong>1 425/005 Plt. Kepala Dinas Pendidikan Pemkot Tegal Persyaratan tidak lengkap936 19/04/2<strong>01</strong>1 0<strong>01</strong>21/PL/04/2<strong>01</strong>1/ULPSekretaris Jenderal Kementerian Luar Negeri (ULPGd.serbaguna Lt.2 )<strong>01</strong>/08/11 06/10/11 1619889580009Hal 45

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>937 20/04/2<strong>01</strong>1 <strong>027</strong>/1880/PBD Sekretaris Daerah Provinsi Jawa Barat 28/06/11 05/10/11 1619889370006938 20/04/2<strong>01</strong>1 620/456/DPU Tam-BM Kepala Dinas PU dan Pertambangan Pemkab Sekadau 27/06/11 05/10/11 1619889040008939 20/04/2<strong>01</strong>1 1157/J13.1/LK/2<strong>01</strong>1940 20/04/2<strong>01</strong>1 131/DSDAD-SEKRT/IV/2<strong>01</strong>1Kepala Pusat pengembangan dan PemberdayaanPendidik dan Tenaga Kependidikan Bidang Mesin danTeknik Industri Kementerian Pendidikan NasionalKepala Dinas Sumber Daya Air dan Drainase PemkotBanjarmasin<strong>01</strong>/08/11 06/10/11 161988944000628/06/11 05/10/11 1619888760006941 20/04/2<strong>01</strong>1 050/230/437.21/2<strong>01</strong>1 Sekretaris Daerah Pemkab Gresik <strong>01</strong>/07/11 05/10/11 1619888800009942 20/04/2<strong>01</strong>1 SEK.3-UM.07.05-36 Sekretariat Jenderal Ombudsman RI 28/06/11 05/10/11 1619888870002943 20/04/2<strong>01</strong>1 216/078.54 Camat Ciracas Pemkot Administrasi Jakarta Timur Persyaratan tidak lengkap944 20/04/2<strong>01</strong>1 029/112/2<strong>01</strong>1Kepala Dinas Pendidikan Pemuda dan OlahragaPemprov. MalukuPersyaratan tidak lengkap945 20/04/2<strong>01</strong>1 W9.Fe.PL.<strong>01</strong>.02-169946 20/04/2<strong>01</strong>1 267/-082.74Plt. Kepala Kantor Imigrasi Klas II Wonosobo,Kementerian Hukum dan HAM Kanwil Jawa TengahKepala Puskesmas Kecamatan Pasar Minggu KotaAdministrasi Jakarta Selatan Suku Dinas KesehatanPemprov DKI Jakarta28/06/11 06/10/11 161988950000727/06/11 06/10/11 16198894700<strong>03</strong>947 20/04/2<strong>01</strong>1 600/49/DPU/III/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pamkab Seluma 28/06/11 04/10/11 1619887440008948 20/04/2<strong>01</strong>1 <strong>027</strong>/79/XI/2<strong>01</strong>1949 20/04/2<strong>01</strong>1 045.2/043950 20/04/2<strong>01</strong>1 <strong>027</strong>/141/Distarum/2<strong>01</strong>1951 20/04/2<strong>01</strong>1 141/-078.1Bupati Ogan Komering Ulu Pemkab Ogan KomeringUluWalikota Pekalongan Sekretariat Daerah PemkotPekalonganKepala Dinas Tata Kota dan Perumahan PemkabKotabaruKepala Kantor Perencanaan Pembangunan Kota JakartaBarat Badan Perencanaan Pembangunan DaerahPemprov DKI Jakarta28/06/11 06/10/11 161989004000428/06/11 06/10/11 161988967000728/06/11 06/10/11 161988948000228/06/11 06/09/11 1619885840008952 21/04/2<strong>01</strong>1 445/238/437.76/2<strong>01</strong>1 RSUD Ibnu Sina Pemkab Gresik Persyaratan tidak lengkap953 21/04/2<strong>01</strong>1 176/-084.32Lurah Pulogadung Kecamatan Pulogadung PemkotAdministrasi Jakarta Timur28/06/11 06/10/11 1619889510006954 21/04/2<strong>01</strong>1 800/77/35.09.15/2<strong>01</strong>1 Camat Sukorambi Pemkab Jember 28/06/11 06/10/11 1619889740007Hal 46

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>955 21/04/2<strong>01</strong>1 <strong>027</strong>/1128/PAD Bupati Kendal Sekretariat Daerah Pemkab Kendal 28/06/11 06/10/11 1619889660008956 21/04/2<strong>01</strong>1 BUK.020/819/Bapp/IV/2<strong>01</strong>1 Bupati Lembata Sekretariat Daerah Pemkab Lembata 28/06/11 06/10/11 1619889590008957 21/04/2<strong>01</strong>1 S1-1.853.161958 21/04/2<strong>01</strong>1 253/SM/KU.02.<strong>01</strong>/IV/2<strong>01</strong>1Plt. Kepala Suku Dinas Kebudayaan PemkotAdministrasi Jakarta BaratKepala Biro Umum Sekretariat KementerianPerumahan Rakyat28/06/11 05/10/11 16198896300<strong>01</strong>28/06/11 05/10/11 1619889340009959 25/04/2<strong>01</strong>1 23/IAPI/SP/IV/2<strong>01</strong>1 Wakil Sekretariat Jendral DPP IAPI 28/06/11 05/10/11 1619889000002960 25/04/2<strong>01</strong>1 24/IAPI/SP/IV/2<strong>01</strong>1 Wakil Sekretariat Jendral DPP IAPI 28/06/11 06/10/11 1619889350008961 25/04/2<strong>01</strong>1 893.3/328/V/2<strong>01</strong>1 Bupati Muara Enim 28/06/11 06/10/11 1619889620002962 25/04/2<strong>01</strong>1 368/PU-U/IV/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkab Sukamara 28/06/11 06/10/11 16198894900<strong>01</strong>963 25/04/2<strong>01</strong>1 800/333/ADPEM/2<strong>01</strong>1 Walikota Serang Sekretaris Daerah Pemkot Serang 28/06/11 06/10/11 16198900700<strong>01</strong>964 25/04/2<strong>01</strong>1 523/197/I/2<strong>01</strong>1965 25/04/2<strong>01</strong>1 781.H30.6/PP/11966 25/04/2<strong>01</strong>1 W14.PL.02.<strong>03</strong>-<strong>03</strong>Kepala Dinas Kelautan dan Perikanan PemkabBengkulu UtaraKetua Jurusan Akuntansi Fakultas EkonomiUniversitas Bengkulu KemdiknasKepala Kanwil Sulawesi Utara Kementerian Hukumdan HAM28/06/11 06/10/11 161988942000828/06/11 06/10/11 16198896300<strong>01</strong>28 Ju ni 2<strong>01</strong>1 06/10/11 1619889550002967 25/04/2<strong>01</strong>1 420/4759/III.<strong>01</strong>/DP.2/2<strong>01</strong>1 Kepala Dinas Pendidikan Pemprov Lampung 28/06/11 06/10/11 1619889460004968 25/04/2<strong>01</strong>1 800/390/BKD-S/2<strong>01</strong>1 Kepala BKD Pemkot Pontianak 28/06/11 06/10/11 16198896100<strong>03</strong>969 25/04/2<strong>01</strong>1 <strong>027</strong>/<strong>01</strong>349970 25/04/2<strong>01</strong>1 800/208/IV/Peg971 25/04/2<strong>01</strong>1 893/360/iv/2<strong>01</strong>1Walikota Semarang Sekreatriat Daerah PemkotSemarangKepala Dinas Pekerjaan Umum Pemprov KalimantanTengahKepala Dinas Pekerjaan Umum Pemprov KalimantanTimur<strong>01</strong>/07/11 06/10/11 161988969000528/06/11 06/10/11 16198895400<strong>03</strong>28/06/11 05/10/11 1619888840005972 25/04/2<strong>01</strong>1 893.3/1.1/620/Diklat-SU/2<strong>01</strong>1 Kepala Badiklat Pemprov. Sumatera Utara Sudah lulus ujian973 25/04/2<strong>01</strong>1 800/1028/RSU974 25/04/2<strong>01</strong>1 800/0421Direktur RSUD Sanjiwani Kabupaten Gianyar PemkabGianyarKepala Bagian Kepegawaian Direksi PDAM TirtaMoedal Pemkot Semarang28/06/11 06/10/11 161988965000928/06/11 06/10/11 1619890060002Hal 47

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>975 25/04/2<strong>01</strong>1 S-4493/WPJ.09/KP.0609/2<strong>01</strong>1Kepala KPP Pratama Cianjur Kantor Wilayah DJPJawa Barat I Dirjend Pajak Kementerian KeuanganPersyaratan tidak lengkap976 25/04/2<strong>01</strong>1 UM.06.02/W.05/ Kepala Dinas Pekerjaan Umum Pemprov Jambi 28/06/11 20/09/11 1619887150006977 25/04/2<strong>01</strong>1 281/Ses.Prov/<strong>01</strong>6/IV/2<strong>01</strong>1 Sekretaris Komisi Pemilihan Umum Provinsi Bali Persyaratan tidak lengkap978 25/04/2<strong>01</strong>1 045.2/138/DBMP/BM-A979 25/04/2<strong>01</strong>1 <strong>027</strong>/261/SET/2<strong>01</strong>1Kepala Dinas Bina Marga dan Pengairan PemkabKapuas HuluBupati Kabupaten Fakfak Sekretaris Daerah PemkabFakfak28/06/11 06/10/11 161988957000028/06/11 06/10/11 16198895600<strong>01</strong>980 26/04/2<strong>01</strong>1 139A/Bua.3/IV/2<strong>01</strong>1 KPA Badan Urusan Administrasi Mahkamah Agung 28/06/11 06/10/11 1619889520005981 26/04/2<strong>01</strong>1 69/9.2-100.9/IV/2<strong>01</strong>1 Kapusdiklat Badan Pertanahan Nasional 28/06/11 06/10/11 1616409020007982 26/04/2<strong>01</strong>1 050/Ad.Pemb/269 Bupati Kampar Sekretariat Daerah Pemkab Kampar 28/06/11 06/10/11 1619889770004983 26/04/2<strong>01</strong>1 120.04/110Kepala Balai Pemberdayaan dan Pengawasan JasaKonstruksi Dinas Cipta Karya dan Tata RuangPemprov Jawa Tengah28/06/11 10/10/11 16198898500<strong>03</strong>984 26/04/2<strong>01</strong>1 800/196/Inspektorat/2<strong>01</strong>1 Inspektur Kabupaten Merangin 28/06/11 07/10/11 1619890750002985 26/04/2<strong>01</strong>1 <strong>027</strong>/183/I/BLHP/2<strong>01</strong>1986 26/04/2<strong>01</strong>1 KP.4<strong>03</strong>/229/IV/MNI-2<strong>01</strong>1Kepala Badan Lingkungan Hidup dan PenelitianProvinsi NTBKepala Stasiun Geofisika Manado Badan MeteorologiKlimatologi dan Geofisika28/06/11 06/10/11 16198895600<strong>01</strong>28/06/11 07/10/11 1619890770000987 26/04/2<strong>01</strong>1 835/PL7/PER/2<strong>01</strong>1 Direktur Politeknik Negeri Samarinda Kemdiknas 28/06/11 06/10/11 1619889970008988 26/04/2<strong>01</strong>1 W9.Ff-PL.02.<strong>03</strong>-0642Kepala Kantor Imigrasi Pati Kanwil Jawa TengahKementerian Hukum dan HAMPersyaratan tidak lengkap989 26/04/2<strong>01</strong>1 <strong>027</strong>/T.143 Inspektur Daerah Pemkab Gunungkidul 28/06/11 07/10/11 1619890780009990 26/04/2<strong>01</strong>1 6<strong>01</strong>/562/III/program Bupati Bone Sekretariat Daerah Pemkab Bone 28/06/11 06/10/11 1619890020006991 26/04/2<strong>01</strong>1 PR 02 02-BJ/232Kepala Balai Besar Pelaksanaan Jalan Nasional XDirjend Bina Marga Kementerian PU28/06/11 07/10/11 1619890700007992 26/04/2<strong>01</strong>1 116/III.7/TVRI/2<strong>01</strong>1 Kepala TVRI Stasiun Jambi Persyaratan tidak lengkap993 26/04/2<strong>01</strong>1 800/721/Dalprog/11 Sekretaris Daerah Pemkab Sukabumi 28/06/11 07/10/11 1619890240008994 26/04/2<strong>01</strong>1 570/set/117 Kepala BPMD Provinsi Maluku Persyaratan tidak lengkapHal 48

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>995 26/04/2<strong>01</strong>1 B/223/IV/2<strong>01</strong>1Komandan Denzibang 3/IV Zeni Kodam IVDiponegoro28/06/11 06/10/11 1619890890005996 26/04/2<strong>01</strong>1 760/71/1/DPUK/II/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkab Bulungan Persyaratan tidak lengkap997 26/04/2<strong>01</strong>1 KP2TSP.TTU.5<strong>03</strong>/050/IV/2<strong>01</strong>1998 27/04/2<strong>01</strong>1 800-61/disnakertrans/2<strong>01</strong>1999 27/04/2<strong>01</strong>1 523/146/DKP/2<strong>01</strong><strong>01</strong>000 27/04/2<strong>01</strong>1 <strong>027</strong>/<strong>01</strong>/IV/BAP/2<strong>01</strong>1Bupati Timor Tengah Utara Kantor PelayananPerijinan Terpadu Satu Pintu (KP@TSP) Kab. TTUKepala Dinas Tenaga Kerja dan TransmigrasiKabupaten LangkatKepala Dinas Kelautan dan Perikanan PemkotBengkuluBupati Muaro Jambi Sekretariat Daerah Pemkab MuaroJambi28/06/11 07/10/11 161989079000828/06/11 07/10/11 16198907600<strong>01</strong>Persyaratan tidak lengkapPersyaratan tidak lengkap10<strong>01</strong> 27/04/2<strong>01</strong>1 2353/LKI-54/2<strong>01</strong>1 Ketua Lembaga Kajian Indonesia 28/06/11 10/10/11 16198899100041002 27/04/2<strong>01</strong>1 050/193/2<strong>01</strong>110<strong>03</strong> 27/04/2<strong>01</strong>1 800/196/D.16/2<strong>01</strong>1Kepala Dinas Kelautan Perikanan dan PeternakanPemkab TegalKepala Dinas Pendapatan dan Pengelolaan KeuanganDaerah Pemkab Lampung Tengah28/06/11 06/10/11 1619890870007Persyaratan tidak lengkap1004 27/04/2<strong>01</strong>1 Kd.21.07/6/KP.00/373/2<strong>01</strong>1 Kepala Kantor Kabupaten Maros Kementerian Agama Persyaratan tidak lengkap1005 27/04/2<strong>01</strong>1 B/1491-09/20/86/Slog Panglima TNI 28/06/11 06/10/11 161989<strong>01</strong>200<strong>03</strong>1006 27/04/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/I/<strong>01</strong>120/2<strong>01</strong>1 Direktur RSKusta Dr. Sitanala Tanggerang 28/06/11 06/10/11 16198895300041007 27/04/2<strong>01</strong>1 171/DPP-SEK/IV/2<strong>01</strong>11008 27/04/2<strong>01</strong>1 B/225/IV/2<strong>01</strong>1Kepala Dinas Perindustrian dan Perdagangan Pemprov.Kepulauan RiauKepala Perhubungan Komando Daerah MiliterXVI/Pattimura28/06/11 06/10/11 1619889400000Sudah lulus ujian1009 27/04/2<strong>01</strong>1 028/02580/04/2<strong>01</strong>1 Sekretaris Daerah Pemkab Boyolali 28/06/11 06/10/11 16198893900041<strong>01</strong>0 27/04/2<strong>01</strong>1 910/1674/415.10.5/2<strong>01</strong>1 Bupati Jombang Sekretariat Daerah Pemkab Jombang 10/06/11 06/10/11 161989008000<strong>01</strong><strong>01</strong>1 27/04/2<strong>01</strong>1 1617/-084.251<strong>01</strong>2 27/04/2<strong>01</strong>1 KP.004/069/04/OP.2<strong>01</strong>1Kepala Biro Pendidikan dan Mental Spiritual SetdaProvinsi DKI JakartaKepala Bandar Udara Pangsuma Putussibau DirjendPerhubungan Udara Kementerian Perhubungan28/06/11 06/10/11 161989<strong>01</strong>1000428/06/11 06/10/11 161989<strong>01</strong>30002Hal 49

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1<strong>01</strong>3 27/04/2<strong>01</strong>1 W9.Ca.PL.02.<strong>03</strong>-63Ketua Balai Harta Peninggalan Semarang KementerianHukum dan HAM Kanwil Jawa TengahPersyaratan tidak lengkap1<strong>01</strong>4 28/04/2<strong>01</strong>1 898/527-BKPPD/2<strong>01</strong>1Kepala Badan Kepegawaian, Pendidikan dan PelatihanDaerah Pemkot Banjar<strong>01</strong>/07/11 06/10/11 161989<strong>01</strong>000051<strong>01</strong>5 28/04/2<strong>01</strong>1 05136/KP05<strong>01</strong>/IV/2<strong>01</strong>1 Kepala Biro Umum Badan Tenaga Nuklir Nasional 28/06/11 06/10/11 16198893800051<strong>01</strong>6 28/04/2<strong>01</strong>1 Un.5/<strong>03</strong>/PMU-IDB/IV/2<strong>01</strong>1 Rektor UIN Sunan Gunung Djati Bandung 28/06/11 06/10/11 16198894100091<strong>01</strong>7 28/04/2<strong>01</strong>1 - an Agung Prahardanto Persyaratan tidak lengkap1<strong>01</strong>8 28/04/2<strong>01</strong>1 2222A/PL4/TU/2<strong>01</strong>1 Direktur Politeknik Negeri Semarang 28/06/11 07/10/11 16198902600061<strong>01</strong>9 28/04/2<strong>01</strong>1 <strong>027</strong>/029<strong>01</strong>020 28/04/2<strong>01</strong>1 <strong>027</strong>/1279/Ro.UHPKepala Badan Kesatuan Bangsa, Politik danPerlindungan Masyarakat Pemerintah AcehKepala Biro Umum Humas dan Protokol Setda Prov.DIY28/06/11 06/10/11 161988999000628/06/11 07/10/11 16198907300041021 28/04/2<strong>01</strong>1 600/158/PUD/IV/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkab Takalar 28/06/11 06/10/11 16198900900091022 28/04/2<strong>01</strong>1 Skrt.890/250/IV/2<strong>01</strong>1Kepala Dinas Pertanian dan Kehutanan PemkabLembata28/06/11 07/10/11 16198907400<strong>03</strong>1023 28/04/2<strong>01</strong>1 594.3/1818 Kepala Dinas Perindustrian dan Perdagangan 28/06/11 06/10/11 161989<strong>01</strong>5000<strong>01</strong>024 28/04/2<strong>01</strong>1 800/1<strong>01</strong>/34/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkab Tanggamus 28/06/11 06/10/11 161989<strong>01</strong>600091025 28/04/2<strong>01</strong>1 642/293.a/42/05/2<strong>01</strong>11026 28/04/2<strong>01</strong>1 524/10B/31/2<strong>01</strong>1Kepala Dinas Pendidikan Pemuda dan OlahragaPemkab TanggamusKepala Dinas Peternakan dan Kesehatan HewanPemkab Tanggamus28/06/11 06/10/11 161989<strong>01</strong>70008Sudah lulus ujian1<strong>027</strong> 28/04/2<strong>01</strong>1 346/II.5/TVRI/2<strong>01</strong>1 Kepala LPP TVRI Stasiun Sumatera Selatan 28/06/11 06/10/11 16198900000081028 28/04/2<strong>01</strong>1 1<strong>01</strong>2/H4.32.2/UM.13/2<strong>01</strong>11029 28/04/2<strong>01</strong>1 Dm.02.02/I/958/2<strong>01</strong>11<strong>03</strong>0 28/04/2<strong>01</strong>1 <strong>027</strong>/2871/DPUDekan Fakultas Farmasi Universitas HasanuddinKemdiknasDirektur Politeknik Kesehatan Jakarta III KementerianKesehatanGubernur Bengkulu, Sekretariat Daerah PemprovBengkulu28/06/11 06/10/11 161989<strong>01</strong>400<strong>01</strong><strong>01</strong>/07/11 10/10/11 1619889820006Sudah lulus ujian1<strong>03</strong>1 28/04/2<strong>01</strong>1 600/BP2JK-511/DPU/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemprov NTB <strong>01</strong>/07/11 10/10/11 1619889830005Hal 50

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1<strong>03</strong>2 28/04/2<strong>01</strong>1 264/DTRCKP-1/2<strong>01</strong>1Kepala Dinas Tata Ruang, Cipta Karya dan PerumahanPemkot Banjarmasin28/06/11 10/10/11 16198909000<strong>01</strong>1<strong>03</strong>3 28/04/2<strong>01</strong>1 893.3/893/10 Kepala Badan Kepegawaian Daerah Pemkab Klaten Sudah lulus ujian1<strong>03</strong>4 28/04/2<strong>01</strong>1 S-0600/WPB.18/BG.<strong>01</strong><strong>03</strong>/2<strong>01</strong>11<strong>03</strong>5 28/04/2<strong>01</strong>1 045.2/029/1.20.<strong>03</strong>.9/2<strong>01</strong>1Kepala Kanwil Prov. Kalimantan Tengah DirjendPerbendaharaan Kementerian KeuanganBupati Bangka barat Sekretariat Daerah PemkabBangka Barat28/06/11 10/10/11 1619889930002<strong>01</strong>/07/11 06/10/11 1619890<strong>01</strong>00071<strong>03</strong>6 28/04/2<strong>01</strong>1 602/040/Setda-Bang/2<strong>01</strong>1 Plt. Sekretaris Daerah Pemkab Padang Pariaman 15/07/11 10/10/11 161989<strong>027</strong>00051<strong>03</strong>7 28/04/2<strong>01</strong>1 870/259/BAP1<strong>03</strong>8 28/04/2<strong>01</strong>1 800.08/BMSDA/III/2<strong>01</strong>1/951<strong>03</strong>9 29/04/2<strong>01</strong>1 Blt.02/1/KP.<strong>01</strong>.2/623.a/2<strong>01</strong>11040 29/04/2<strong>01</strong>1 640/60/V/2<strong>01</strong>11041 29/04/2<strong>01</strong>1 893.3/21/B.Tek/2<strong>01</strong>11042 29/04/2<strong>01</strong>1 B.429/P2KTrans-SES/IV/2<strong>01</strong>11043 29/04/2<strong>01</strong>1 660/274/BLH-LU/IV/2<strong>01</strong>11044 29/04/2<strong>01</strong>1 PHN.1-UM.<strong>01</strong>.<strong>01</strong>-96Bupati Muaro Jambi Sekretariat Daerah Pemkab MuaroJambiKepala Dinas Bina mArda dan Sumber Daya AirPemkab PelalawanKepala Balai Penelitian dan Pengembangan AgamaSemarang, Kementerian AgamaBupati Ogan Komering Ilir Sekretariat Daerah PemkabOgan Komering IlirKepala Badan Pendidikan dan Pelatihan Pemprov.Sumatera BaratPlh. Sekretaris Dirjend Pembinaan PembangunanKawasan TransmigrasiKepala Badan Lingkungan Hidup Kabupaten LampungUtaraPlh. Sekretaris Badan Pembinaan Hukum NasionalKementerian Hukum dan HAM15/07/11 10/10/11 161988984000428/06/11 04/10/11 161988517000628/06/11 04/10/11 161988514000915/07/11 05/10/11 161988863000209/09/11 10/10/11 1619889860002<strong>01</strong>/07/11 10/10/11 1619890280004<strong>01</strong>/07/11 07/10/11 1619890230009<strong>01</strong>/07/11 06/10/11 1619890<strong>03</strong>00051045 29/04/2<strong>01</strong>1 540/141/SET-DPU Kepala Dinas Pekerjaan Umum Pemkab Kotabaru 15/07/11 10/10/11 16198899600091046 29/04/2<strong>01</strong>1 S-2343/WPJ.07/2<strong>01</strong>1Kepala Kanwil DJP Jakarta Khusus Dirjend PajakKementerian Keuangan<strong>01</strong>/07/11 07/10/11 16198908800061047 29/04/2<strong>01</strong>1 600/588 Walikota Baubau Sekretariat Daerah Pemkab Baubau <strong>01</strong>/07/11 10/10/11 16198899200<strong>03</strong>1048 29/04/2<strong>01</strong>1 522/518/2<strong>01</strong>1Kepala Dinas Pertanian Peternakan Perkebunan danKehutanan Pemkab PekalonganSertifikat masih berlaku dantidak melampirkan FotoCopy sertifikat1049 29/04/2<strong>01</strong>1 <strong>027</strong>/0462/Bina Program/2<strong>01</strong>1 Bupati Karo, Sekretariat Daerah Pemkab Karo 09/09/11 10/10/11 1619890910000Hal 51

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1050 29/04/2<strong>01</strong>1 428/J6/LK/2<strong>01</strong>1Kepala PPPPTK Penjas dan BK KementerianPendidikan NasionalSudah lulus ujian1051 29/04/2<strong>01</strong>1 <strong>03</strong>2/IAPI/SP/IV/2<strong>01</strong>1 Wakil Sekretariat Jendral DPP IAPI <strong>01</strong>/07/11 10/10/111052 29/04/2<strong>01</strong>1 <strong>03</strong>3/IAPI/SP/IV/2<strong>01</strong>1 Wakil Sekretariat Jendral DPP IAPI <strong>01</strong>/07/11 07/10/111053 02/05/2<strong>01</strong>1 800/1233/I.06/2<strong>01</strong>1Bupati Lampung Selatan Sekretariat Daerah PemkabLampung Selatan<strong>01</strong>/07/11 11/10/11 161989<strong>03</strong>300061054 02/05/2<strong>01</strong>1 800/3309 Sekretaris DPRD Kota Medan <strong>01</strong>/07/11 10/10/11 16198897900021055 02/05/2<strong>01</strong>1 050/230/437.21/2<strong>01</strong>1 Sekretaris Daerah Pemkab Gresik Sudah lulus ujian1056 02/05/2<strong>01</strong>1 522.028/710/I/Kehut/2<strong>01</strong>1 Kepala Dinas Kehutanan Pemkab Musi Rawas <strong>01</strong>/07/11 10/10/11 16198898100071057 02/05/2<strong>01</strong>1 142/600/PU-RN/IV/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkab Rote Ndao 28/06/11 07/10/11 16198902500071058 02/05/2<strong>01</strong>1 600/39/DPU-HS/2<strong>01</strong>1Kepala Dinas Pekerjaan Umum dan KimpraswilPemkab Halmahera Selatan<strong>01</strong>/07/11 10/10/11 16198902900<strong>03</strong>1059 02/05/2<strong>01</strong>1 050/1126/VI Bupati Grobogan Sekretariat Daerah Pemkab Grobogan 09/09/11 07/10/11 16198907100061060 02/05/2<strong>01</strong>1 B.466/BKIPMI/TU.230/1V/2<strong>01</strong>1Sekretaris BKIPM Kementerian Kelautan danPerikanan09/09/11 07/10/11 16198909400071061 02/05/2<strong>01</strong>1 Ad.Pemb.<strong>027</strong>/47/<strong>03</strong>/2<strong>01</strong>1 Bupati Ngada Pemprov NTT <strong>01</strong>/07/11 10/10/11 161988995000<strong>01</strong>062 02/05/2<strong>01</strong>1 660/304/416-2<strong>03</strong>.A/2<strong>01</strong>1 Kepala Badan Lingkungan Hidup Pemkab Mojokerto <strong>01</strong>/07/11 07/10/11 16198899800071063 02/05/2<strong>01</strong>1 UK.346/1/1/DNG.Sbg-2<strong>01</strong>11064 02/05/2<strong>01</strong>1 W9.Ff-PL.02.<strong>03</strong>-06411065 02/05/2<strong>01</strong>1 S.68/BPDAS.BB-<strong>01</strong>/2<strong>01</strong>1Kepala Distrik Navigasi Kelas III Sibolga DirjendPerhubungan Laut Kementerian PerhubunganKepala Kantor Imigrasi Pati Kanwil Jawa TengahKementerian Hukum dan HAMKepala Balai Pengelolaan DAS Bone Bolango DirjendBina Pengelolaan DAS dan Perhutanan SosialKementerian Kehutanan<strong>01</strong>/07/11 10/10/11 1619889800008Persyaratan tidak lengkapPersyaratan tidak lengkap1066 02/05/2<strong>01</strong>1 500/EKON/341 Bupati Bintan Sekretariat Daerah Pemkab Bintan <strong>01</strong>/07/11 07/10/11 16198907200051067 02/05/2<strong>01</strong>1 S-97/WPJ.32/KP.<strong>01</strong><strong>01</strong>/2<strong>01</strong>11068 02/05/2<strong>01</strong>1 UM.0<strong>01</strong>5/S.146/LOKA-TTE/V/2<strong>01</strong>1Kepala KPP Pratama Purwokerto Kanwil Jawa TengahII Dirjend Pajak Kementerian KeuanganKepala Loka Monitor SFR Dirjend Sumber Daya danPerangkat Pos dan Informatika KemmenterianKominfo<strong>01</strong>/07/11 07/10/11 16198908300<strong>01</strong><strong>01</strong>/07/11 07/10/11 1619890840000Hal 52

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1069 <strong>03</strong>/05/2<strong>01</strong>1 Kd.29.05/Ku.00.1/224/2<strong>01</strong>11070 <strong>03</strong>/05/2<strong>01</strong>1 173/-1.713.41071 <strong>03</strong>/05/2<strong>01</strong>1 -Kepala Kantor Kabupaten Bangka TengahKementerian AgamaLurah Cibubur Kecamatan Ciracas Kota AdministrasiJakarta Timur Pemprov. DKI JakartaDekan Fakultas Tarbiyah dan Keguruan UIN AlauddinMakassar Kementerian Agama<strong>01</strong>/07/11 07/10/11 1619890850009<strong>01</strong>/07/11 10/10/11 161989092000909/09/11 10/10/11 16198909300081072 <strong>03</strong>/05/2<strong>01</strong>1 600/418/PUK.I/2<strong>01</strong>1 Kepala Dinas PU Kabupaten Tapanuli Utara 09/09/11 10/10/11 16198907100061073 <strong>03</strong>/05/2<strong>01</strong>1 873.5/052/DPPKA-EKepala Dinas Pendapatan, Pengelolaan Keuangan danAset Kota Singkawang09/09/11 10/10/11 16198899400<strong>01</strong>1074 <strong>03</strong>/05/2<strong>01</strong>1 028/390/Dishut Kepala Dinas Kehutanan Pemprov Bali Persyaratan tidak lengkap1075 <strong>03</strong>/05/2<strong>01</strong>1 S.147/I/III/P3PIK.1/2<strong>01</strong>11076 04/05/2<strong>01</strong>1 893.3/0984/436.7.6/2<strong>01</strong>1Kepala Pusat Litbang Perubahan Iklim dan KebijakanBalitbang Kehutanan Kementerian KehutananKepala Badan Kepegawaian dan Diklat PemkotSurabaya05/08/11 07/10/11 161989086000815/07/11 14/10/11 161198927400<strong>01</strong>1077 04/05/2<strong>01</strong>1 050/8123/PEMB/2<strong>01</strong>1 Walikota Tanjung Balai 10/06/11 07/10/11 16198906900<strong>01</strong>1078 04/05/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>.1.306 Kepala Bapelkes Salaman Magelang Persyaratan tidak lengkap1079 04/05/2<strong>01</strong>1 050/36671080 04/05/2<strong>01</strong>1 B-983/Ro.Um/IV/2<strong>01</strong>1Bupati Aceh Timur, Sekretariat Daerah Pemkab AcehTimurKepala Biro Umum Kementerian Koordinator BidangKesejahteraan Rakyat<strong>01</strong>/07/11 07/10/11 1619890950006<strong>01</strong>/07/11 07/10/11 16198906800021081 04/05/2<strong>01</strong>1 600/DPU-SEK/200 Kepala Dinas Pekerjaan Umum Pemkab Lingga <strong>01</strong>/07/11 11/10/11 161989<strong>03</strong>100081082 04/05/2<strong>01</strong>1 PH.344/1/<strong>01</strong>/Kpl.Im-11Kepala Kantor Unit Penyelenggara Pelabuhan Kelas IIIIndramayu Dirjend Pehubungan Laut KementerianPerhubunganPersyaratan tidak lengkap1083 04/05/2<strong>01</strong>1 LOG.4/2104/IV/2<strong>01</strong>1 Kepala Kepolisian Daerah NTB Persyaratan tidak lengkap1084 04/05/2<strong>01</strong>1 2477/Ses/04/2<strong>01</strong>1 Sekretaris Menteri PPN/ Sekretaris Utama Bappenas 15/07/11 11/10/11 16198905600071085 04/05/2<strong>01</strong>1 <strong>027</strong>/345/2<strong>01</strong>1 Kepala Dinas Bina Marga Pemkab Aceh Utara Sudah lulus ujian1086 04/05/2<strong>01</strong>1 640/220/PUP/2<strong>01</strong>1Kepala Dinas Pekerjaan Umum dan PerumahanPemkab Kepulauan Yapen<strong>01</strong>/07/11 11/10/11 1619891580004Hal 53

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1087 05/05/2<strong>01</strong>1 B/3297/08/23/1/BARANAHANKepala Badan Sarana Pertahanan KementerianPertahanan<strong>01</strong>/07/11 11/10/11 16198915600061088 05/05/2<strong>01</strong>1 <strong>027</strong>/2095/IV/2<strong>01</strong>1 Bupati Banyumas, Setda Pemkab Banyumas 09/09/11 11/10/11 16198915400081089 05/05/2<strong>01</strong>1 UM.002/V/18/5/PDI.2<strong>01</strong>1Kepala Pusat Data dan Informasi KementerianPerhubungan09/09/11 11/10/11 161989<strong>03</strong>200071090 05/05/2<strong>01</strong>1 861/05/Setdako/309/2<strong>01</strong>1 Walikota Manado, Setda Kota Pemkot Manado 09/09/11 11/10/11 161989<strong>03</strong>800<strong>01</strong>1091 05/05/2<strong>01</strong>1 620.1/0689/19Plt. Kepala Dinas Bina Marga SDA Energi dan SumberDaya Mineral Pemkab Cilacap28/06/11 11/10/11 161989<strong>01</strong>800071092 05/05/2<strong>01</strong>1 050/0<strong>01</strong>31/Pemb. Bupati Banjar, Sekretariat Daerah Pemkab Banjar 29/06/11 11/10/11 16198915900<strong>03</strong>1093 05/05/2<strong>01</strong>1 2916/H5.1.R2/PSS/2<strong>01</strong>1 Rektor Universitas Sumatera Utara 15/07/11 11/10/11 161989<strong>03</strong>600<strong>03</strong>1094 05/05/2<strong>01</strong>1 <strong>027</strong>/1408/2<strong>01</strong>11095 05/05/2<strong>01</strong>1 075/740/DKP-TU/IV/2<strong>01</strong>11096 05/05/2<strong>01</strong>1 050/028/ADPKepala Badan Pelaksana Penyuluhan dan Pertanian,Perikanan dan Kehutanan Pemkab PekalonganKepala Dinas Kelautan dan Perikanan Pemkab KutaiTimurBupati Tanjung Jabung Barat, Sekretariat DaerahPemkab Tanjung Jabung Barat<strong>01</strong>/07/11 11/10/11 161989<strong>03</strong>90000<strong>01</strong>/07/11 11/10/11 1619890530000<strong>01</strong>/07/11 11/10/11 161989<strong>03</strong>500041097 05/05/2<strong>01</strong>1 050/081/Ev.Bang Sekreatris Daerah Pemkot Bontang <strong>01</strong>/07/11 11/10/11 161989<strong>03</strong>400051098 05/05/2<strong>01</strong>1 0452/212/IV/2<strong>01</strong>11099 05/05/2<strong>01</strong>1 800/219/IV/2<strong>01</strong>11100 06/05/2<strong>01</strong>1 870/222/DPU-KB/V/2<strong>01</strong>111<strong>01</strong> 06/05/2<strong>01</strong>1 285/H39.5/FIP/LL/2<strong>01</strong>11102 06/05/2<strong>01</strong>1 090/475/2<strong>01</strong>111<strong>03</strong> 06/05/2<strong>01</strong>1 800.5/666/KP/Nakertrans1104 06/05/2<strong>01</strong>1 <strong>027</strong>/0718/SEKKepala Biro Pembangunan Sekretariat Darah PemprovKepulauan Bangka BelitungKepala Biro Pembangunan Sekretariat Darah PemprovKepulauan Bangka BelitungDinas Pekerjaan Umum dan Kimpraswil Pemkab KutaiBaratDekan Fakultas Ilmu Pendidikan Universitas NegeriJakartaKepala Dinas Tenaga Kerja dan Transmigrasi PemkabMaluku TengahKepala Dinas Tenaga Kerja dan Transmigrasi PemprovKalimantan TengahKepala Dinas Pendapatan Daerah Pemprov SulawesiTengah15/07/11 11/10/11 161989040000615/07/11 11/10/11 161989040000615/07/11 10/10/11 161988990000515/07/11 11/10/11 161989152000009/09/11 10/10/11 16198898700<strong>01</strong>Persyaratan tidak lengkapPersyaratan tidak lengkap1105 06/05/2<strong>01</strong>1 158/071.511 Camat Kramat Jati Pemkot Administrasi Jakarta Timur Persyaratan tidak lengkapHal 54

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1106 06/05/2<strong>01</strong>1 <strong>027</strong>/45/PA-A/2<strong>01</strong>1 Bupati Landak Sekretariat Daerah Pemkab Landak 15/07/11 11/10/11 16198905200<strong>01</strong>1107 06/05/2<strong>01</strong>1 524/229 Kepala Dinas Peternakan Pemkab Jayapura 15/07/11 11/10/11 16198905900041108 06/05/2<strong>01</strong>1 767/BPKIMI/BIPA/05/2<strong>01</strong>11109 06/05/2<strong>01</strong>1 S-543/PP.1/2<strong>01</strong>1Kepala Balai Riset dan Standarisasi IndustriPalembang, Badan Pengkajian Kebijakan, Iklim danMutu Industri Kementerian PerindustrianSekretaris Badan Diklat Keuangan KementerianKeuangan15/07/11 11/10/11 161989065000515/07/11 11/10/11 16198914900061110 06/05/2<strong>01</strong>1 PD.02<strong>03</strong>-cb/511Direktur Penataan Bangunan dan Lingkungan DirjendCipta Karya Kementerian Pu (kasubang pu)Persyaratan tidak lengkap1111 09/05/2<strong>01</strong>1 893.3/448 Sekretaris Daerah Pemkab Bireuen <strong>01</strong>/07/11 11/10/11 16198905700061112 09/05/2<strong>01</strong>1 B.0223/MENPORA/D.IV.3/IV/2<strong>01</strong>1 Asdep Kementerian Pemuda dan Olahraga <strong>01</strong>/07/11 11/10/11 16498915700051113 09/05/2<strong>01</strong>1 835/LSN/SU.DL.0<strong>01</strong>/04/2<strong>01</strong>1 Kepala Lembaga Sandi Negara 15/07/11 11/10/11 16198906600041114 09/05/2<strong>01</strong>1 PH.346/1/13/KUPP.SBK-2<strong>01</strong>1Kepala Kantor Unit Penyelenggara Pelabuhan SebukuDitjend Perhubungan Laut Kementerian PerhubunganSudah lulus ujian1115 09/05/2<strong>01</strong>1 Kw.13.11/0/Kp.02.3/0960/2<strong>01</strong>1Kepala Kantor Kabupaten Bondowoso, KementerianAgama<strong>01</strong>/07/11 11/10/11 16198914800071116 09/05/2<strong>01</strong>1 750/248/Itkab-2<strong>01</strong>1 Inspektur Kabupaten Bengkayang <strong>01</strong>/07/11 11/10/11 16198904200041117 09/05/2<strong>01</strong>1 322/UM.002/TBL-05111118 09/05/2<strong>01</strong>1 600/DPU/45/IV/2<strong>01</strong>11119 09/05/2<strong>01</strong>1 650.807/PPRK/142/IV/2<strong>01</strong>1Kepala Bandar Udara Tambolaka Dirjend PerhubunganUdara Kementerian PerhubunganKepala Dinas Pekerjaan Umum Pemkab MalukuTengahKepala Dinas Perumahan, Penataan Ruang danKebersihan Kabupaten Timor Tengah<strong>01</strong>/07/11 11/10/11 1619891470008<strong>01</strong>/07/11 11/10/11 1619891500002Sudah lulus ujian1120 09/05/2<strong>01</strong>1 833/56/2<strong>01</strong>1 Kepala Bappeda Kabupaten Aceh Utara <strong>01</strong>/07/11 11/10/11 161989046000<strong>01</strong>121 09/05/2<strong>01</strong>1 W30.PAS.g-PL.02.30-17<strong>01</strong>122 09/05/2<strong>01</strong>1 1284/PPSC/TU.210/V/2<strong>01</strong>1Kepala Rumah Penyimpanan Benda Sitaan NegaraKelas II Kanwil Kep. Bangka Belitung KemhukhamKepala Pelabuhan Perikanan Samudera Cilacap DirjendPerikanan Tangkap Kementerian Kelautan danPerikananPersyaratan tidak lengkapSudah lulus ujianHal 55

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1123 09/05/2<strong>01</strong>1 W9.E1.PR.<strong>01</strong>.02-289Kepala Lembaga Pemasyarakatan Klas IIA PekalonganKanwil Jawa Tengah Kementerian Hukum dan HAMPersyaratan tidak lengkap1124 09/05/2<strong>01</strong>1 800/286/PDAM-PERS/V/2<strong>01</strong>1 Direktur Utama PDAM Pemkab Wonosobo Persyaratan tidak lengkap1125 09/05/2<strong>01</strong>1 <strong>027</strong>/177/PembPlt. Kepala Badan Koordinasi Pemerintahan danPembangunan Wlayah I Pemprov Jawa Barat<strong>01</strong>/07/11 11/10/11 16198904100051126 09/05/2<strong>01</strong>1 - an Iwan Muliadi <strong>01</strong>/07/11 11/10/11 16198916700021127 09/05/2<strong>01</strong>1 2114/pl-020/a.8/4/2<strong>01</strong>11128 09/05/2<strong>01</strong>1 11/SAFVER-LKT/2<strong>01</strong>1Kepala Pusat Perlindungan Varietas Tanaman danPerizinan Pertanian Setjend Kementerian PertanianKPA Satker PBBKP2K Kabupaten Langkat DirjendPerikanan Budidaya Kementerian Kelautan danPerikanan<strong>01</strong>/07/11 10/10/11 1619890820002<strong>01</strong>/07/11 11/10/11 161989<strong>03</strong>000091129 09/05/2<strong>01</strong>1 B/917/V/2<strong>01</strong>1 Kepala Kepolisian Resor Barito Utara <strong>01</strong>/07/11 11/10/11 161989<strong>03</strong>700021130 10/05/2<strong>01</strong>1 982/-073.6 Direktur RSUD Budhi Asih1131 10/05/2<strong>01</strong>1 <strong>027</strong>/0564/Bina Program/2<strong>01</strong>1 Sekretaris Daerah Kabupaten Karo 27/06/11 11/10/11 1619891620007Tidak ada sosialisasi perpres541132 10/05/2<strong>01</strong>1 B.475/P2KTrans-PARMAS/V/2<strong>01</strong>11133 10/05/2<strong>01</strong>1 W9-PR.<strong>01</strong>.02-1761134 10/05/2<strong>01</strong>1 S-537/KN.1/2<strong>01</strong>11135 10/05/2<strong>01</strong>1 545/-1.8841136 10/05/2<strong>01</strong>1 09021/Kp.430/F1/05/2<strong>01</strong>11137 11/05/2<strong>01</strong>1 600/262/16-LU/2<strong>01</strong>11138 11/05/2<strong>01</strong>1 S-345/WPJ.15/KP.05<strong>01</strong>/2<strong>01</strong>1Direktur Partisipasi Masyarakat Ditjend PembinaanPembangunan Kawasan Transmigrasi KemenakertransKepala Kantor Wilayah Jawa Tengah KementerianHukum dan HAMSekretaris Ditjen Kekayaan Negara KementerianKeuanganKepala Suku Dinas Peternakan dan Perikanan JakartaTimur Dinas Kelautan dan Perikanan Pemprov DKIJakartaSekretaris Ditjen Peternakan dan Kesehatan HewanKementerian PertanianKepala Dinas Pekerjaan Umum Pemkab LampungUtaraKepala KPP Pratama Kendari Kanwil SulawesiSelatan, Barat dan Tenggara Ditjen Pajak KementerianKeuangan<strong>01</strong>/07/11 11/10/11 16198915100<strong>01</strong><strong>01</strong>/07/11 12/10/11 1619891690000<strong>01</strong>/07/11 12/10/11 161989163000615/07/11 11/10/11 1619890630007<strong>01</strong>/07/11 10/10/11 diambil pak reflus28/06/11 11/10/11 1619890640006Persyaratan tidak lengkap1139 11/05/2<strong>01</strong>1 <strong>01</strong>8/IAPI/SP/V/2<strong>01</strong>1 Wakil Sekretariat Jendral DPP IAPI <strong>01</strong>/07/11 10/10/11 1619890550008Hal 56

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1140 11/05/2<strong>01</strong>1 W27.IMI.1.UM.<strong>01</strong>.<strong>01</strong>-1561Kepala Kantor Imigrasi Kelas I Khusu Batam KanwilKepulauan Riau Kementerian Hukum dan HAM15/07/11 11/10/11 16198905500081141 11/05/2<strong>01</strong>1 IK.<strong>01</strong>.OB/34/BWSS-III/2<strong>01</strong>1Kepala Balai Wilayah Sungai Sumatera III DirjendSDA Kementerian PU15/07/11 11/10/11 16198905000<strong>03</strong>1142 11/05/2<strong>01</strong>1 <strong>027</strong>/1857/2<strong>01</strong>1Kepala Dinas Kehutanan dan Perkebunan PemkabAceh UtaraPersyaratan tidak lengkap1143 11/05/2<strong>01</strong>1 763/J12.3.1/PS/2<strong>01</strong>1Kepala Pusat Pengembangan dan PemberdayaanPendidik dan Tenaga Kependidikan Seni dan BudayaKementerian Pendidikan Nasional15/07/11 11/10/11 16198915300091144 11/05/2<strong>01</strong>1 524/937.6/TU-DPKP/V/2<strong>01</strong>1Kepala Dinas Pertanian, Kelautan dan PerikananPemkot Balikpapan16/07/11 11/10/11 16198905100021145 12/05/2<strong>01</strong>1 600/1378/Pemb-B Bupati Ketapang 09/09/11 11/10/11 16198904500<strong>01</strong>1146 12/05/2<strong>01</strong>1 050/2858/2<strong>01</strong>1 Bupati Padang Lawas 15/07/11 11/10/11 16198906100091147 12/05/2<strong>01</strong>1 62/V/PEMB/2<strong>01</strong>1 Sekretaris Daerah Pemkab Enrekang 09/09/11 12/10/11 16198917100051148 12/05/2<strong>01</strong>1 050/77/DISHUKOMINFO/2<strong>01</strong>1Kepala Dinas Perhubungan Komunikasi danInformatika Provinsi Sumatera Barat15/07/11 11/10/11 16198905400091149 12/05/2<strong>01</strong>1 Distan TP 11.A.<strong>03</strong>.1/389/2<strong>01</strong>1Kepala Dinas Pertanian dan Ketahanan PanganKabupaten Timor Tengah SelatanPersyaratan tidak lengkap1150 12/05/2<strong>01</strong>1 050/2350/Ad.Pemb Bupati Simalungun 09/09/11 11/10/11 16198904800081151 12/05/2<strong>01</strong>1 <strong>027</strong>/6<strong>01</strong>-Pemb Sekretaris Daerah Kota Depok 09/09/11 11/10/11 16198904900071152 12/05/2<strong>01</strong>1 905/1443.1/Disdik Kepala Dinas Pendidikan Kabupaten Cirebon 09/09/11 11/10/11 16198904300<strong>03</strong>1153 12/05/2<strong>01</strong>1 <strong>027</strong>/242-PDAM Direktur Utama PDAM Kota Cirebon 09/09/11 12/10/11 16198913200061154 12/05/2<strong>01</strong>1 800/200-Kec.KD/2<strong>01</strong>1 Camat Kelapa Dua Pemkab Tanggerang 28/06/11 12/10/11 16198917200041155 12/05/2<strong>01</strong>1 800/139/D.Hubkom1156 12/05/2<strong>01</strong>1 380/J11/LK/2<strong>01</strong>11157 12/05/2<strong>01</strong>1 440/BKD-06/IV/2<strong>01</strong>1Kepala Dinas Perhubungan Komunikasi danInformatika Provinsi Sulawesi UtaraKepala Pusat Pengembangan dan PemberdayaanPendidik dan Tenaga Kependidikan Ilmu PengetahuanAlam Kementerian Pendidikan NasionalKepala Badan Kepegawaian, Pendidikan dan PelatihanProvinsi Kepulauan Riau09/09/11 12/10/11 161989061000909/09/11 12/10/11 16198913700<strong>01</strong>Persyaratan tidak lengkap1158 13/05/2<strong>01</strong>1 211/-085 Kepala Sekretariat Badan Diklat Provinsi DKI Jakarta Persyaratan tidak lengkap1159 13/05/2<strong>01</strong>1 824/1<strong>01</strong>/600/TU.UP/IV/2<strong>01</strong>1 Kepala Dinas Pekerjaan Umum Pemkab Lebong 09/09/11 12/10/11 1619891310007Hal 57

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1160 13/05/2<strong>01</strong>1 W4-U/3674/KP.10.10/V/2<strong>01</strong>1 Wakil Ketua Pengadilan Tinggi Pekanbaru 09/09/11 12/10/11 16198913600021161 13/05/2<strong>01</strong>1 W4-U/3671/KP.10.10/V/2<strong>01</strong>1 Ketua Pengadilan Tinggi Pekanbaru 09/09/11 12/10/11 16198904900071162 13/05/2<strong>01</strong>1 W4-U10/620/KP.04,05/V/2<strong>01</strong>1 Ketua Pengadilan Negeri Pasir Pengaraian 15/07/11 11/10/11 16198917300<strong>03</strong>1163 13/05/2<strong>01</strong>1 890/1/15/2<strong>01</strong>1 Kepala Dinas Perhubungan Provinsi Maluku 05/08/11 12/10/11 16198916400051164 13/05/2<strong>01</strong>1 050/363/417.110/2<strong>01</strong>1 Sekretaris Daerah Kota Mojokerto 08/09/11 12/10/11 1619891400051165 13/05/2<strong>01</strong>1 062.231.1/Sek/IV/11Kepala Dinas Kebudayaan dan Pariwisata PemprovMaluku1166 13/05/2<strong>01</strong>1 S-29/WPJ.22/BG.<strong>01</strong>04/2<strong>01</strong>1Kepala Kantor Wilayah DJP Jawa Barat II DirjendPajak Kementerian Keuangan27/06/11 11/10/11 16198916100081167 13/05/2<strong>01</strong>1 893/1169/BKD Bupati Sleman 28/06/11 12/10/11 16198912200091168 13/05/2<strong>01</strong>1 456/PPS.BTG/TU.210/V/2<strong>01</strong>11169 13/05/2<strong>01</strong>1 S.322/VI/BP2HP-XV/1/2<strong>01</strong>1Kepala Pelabuhan Perikanan Samudera Bitung DitjenPerikanan Tangkap Kementerian KPKepala Balai Pemantauan Pemanfaatan Hutan ProduksiWilayah XV Makassar, Ditjen Bina Usaha KehutananKementerian Kehutanan1170 13/05/2<strong>01</strong>1 1470/KT.0<strong>03</strong>/H.1/V-2<strong>01</strong>1 Kepala BKKBN Provinsi Jawa TimurPersyaratan tidak lengkapPersyaratan tidak lengkapSertifikat masih berlakuTidak ada sosialisasi,sertifikat masih berlaku, tdkada fotocopy sertifikat1171 13/05/2<strong>01</strong>1 S.991/V/BPDAS.AK-1/2<strong>01</strong>1Kepala Balai Pengelolaan DAS Agam Kuantan DitjendBina Pengelolaan DAS dan Perhutanan SosialKementerian Kehutanan09/09/11 12/10/11 16198912300081172 13/05/2<strong>01</strong>1 600/230.A/16-LU/2<strong>01</strong>1Kepala Dinas Pekerjaan Umum Pemkab LampungUtara09/09/11 12/10/11 16198913900091173 13/05/2<strong>01</strong>1 893.3/307/427.80/2<strong>01</strong>1Kepala Kantor Pendidikan dan Pelatihan KabupatenLumajang09/09/11 12/10/11 16198912800<strong>03</strong>1174 13/05/2<strong>01</strong>1 0756/16.8/LL/2<strong>01</strong>1Panitia Penyelenggara Konversi Sertifikat Ahli PBJFakultas Teknik Universitas Andalas Kemendiknas09/09/11 10/10/11 161989<strong>01</strong>900061175 18/05/2<strong>01</strong>1 <strong>027</strong>/32.1/1/DISHUB KOMINFOKepala Dinas Perhubungan Komunikasi danInformatika Provinsi Sumatera Selatan09/09/11 12/10/11 16198911200021176 18/05/2<strong>01</strong>1 523/471/V/DKP/2<strong>01</strong>0Kepala Dinas Kelautan dan Perikanan PemprovSulawesi Barat09/09/11 12/10/11 16198913500<strong>03</strong>1177 18/05/2<strong>01</strong>1 660/149/BLH/V/2<strong>01</strong>1 Kepala Badan Lingkungan Hidup Kebupaten Kapuas 09/09/11 12/10/11 161989138000<strong>01</strong>178 18/05/2<strong>01</strong>1 272/640.05/DPU/IV/2<strong>01</strong>1Sekretaris Dinas Pekerjaan Umum Pemkab KutaiKartanegara09/09/11 12/10/11 16198912500061179 18/05/2<strong>01</strong>1 893.3/670/BKD Kepala Badan Kepegawaian Kabupaten Klungkung 27/07/11 11/10/11 16198916000091180 18/05/2<strong>01</strong>1 183/074.4 Camat Kebayoran Baru 15/07/11 12/10/11 1619891700006Hal 58

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1181 18/05/2<strong>01</strong>1 600/078/Pemb/2<strong>01</strong>1 Bupati Hulu Sungai Utara 09/09/11 11/10/11 16198916800<strong>01</strong>1182 18/05/2<strong>01</strong>1 S.212/PHM-3/2<strong>01</strong>1Kepala Pusat Hubungan Masyarakat SetjenKementerian KehutananSertifikat msh berlaku1183 18/05/2<strong>01</strong>1 452/RRI-PTK/SEK/2<strong>01</strong>1 Kepala RRI Pontianak Sudah lulus ujian1184 18/05/2<strong>01</strong>1 800/0713/2<strong>01</strong>1 Kepala Dinas PPKAD Kab. Tegal 09/09/11 12/10/11 16198916500041185 18/05/2<strong>01</strong>1 800/413/ITKOT/V/2<strong>01</strong>1 Inspektur Pemkot Balikpapan 09/09/11 12/10/11 16198913300051186 18/05/2<strong>01</strong>1 050/Bappeda-Sekr/2<strong>01</strong>1/526 Kepala BAPPEDA Prov. Riau Sudah lulus ujian1187 18/05/2<strong>01</strong>1 800/DIKES/416/IV/2<strong>01</strong>1 Kepala Dinas Kesehatan Kab. Gorontalo 09/09/11 12/10/11 16198922500051188 18/05/2<strong>01</strong>1 050/00752/Eko. Sekretaris Daerah Provinsi Kalimantan Selatan 09/09/11 12/10/11 16198913900021189 18/05/2<strong>01</strong>1 796/FTP-UGM/KP/2<strong>01</strong>1Dekan Fakultas Teknologi Pertanian UniversitasGadjah Mada09/09/11 04/10/11 16198911800061190 18/05/2<strong>01</strong>1 045/060/P.Prog./III/2<strong>01</strong>1 Plt. Sekretaris Daerah Pemkab Malinau 09/09/11 12/10/11 16198911800061191 18/05/2<strong>01</strong>1 5180/-078.54Kepala Badan Pengelola Lingkungan Hidup DaerahProvinsi DKI Jakarta1192 18/05/2<strong>01</strong>1 63/BPP/V/2<strong>01</strong>1Kepala Bidang Pasca Panen Pertanian Dinas Kelautandan Pertanian Provinsi DKI Jakarta1193 18/05/2<strong>01</strong>1 341/07/II.02/TU/RSU/2<strong>01</strong>1 Direktur RSUD Waikabubak Pemkab Sumba Barat09/09/11 12/10/11 16198913400041194 19/05/2<strong>01</strong>1 263/J25.2/PR/2<strong>01</strong>1 Kepala LPMP Bengkulu KemdiknasKepala Kantor Pelayanan Kekayaan Negara dan Lelang1195 19/05/2<strong>01</strong>1 S-519/WKN.12/KNL.<strong>03</strong>/2<strong>01</strong>1 (KPKNL) Banjarmasin Kanwil XII DJKN Banjarmasin 09/09/11 13/10/11 16198925800<strong>03</strong>Ditjend Kekayaan Negara Kementerian Keuangan1196 19/05/2<strong>01</strong>1 800/192/421.023/2<strong>01</strong>1 Bupati Malang 09/09/11 12/10/11 1619891100004Tidak ada sosialisasi perpres54Tidak ada sosialisasi perpres54Sudah lulus ujian dansertifikat masih berlaku1197 19/05/2<strong>01</strong>1 893/67/Nakertrans/2<strong>01</strong>1 Kepala Disnakertrans Pemkab Tojo Una-una 09/09/11 12/10/11 16198916700021198 19/05/2<strong>01</strong>1 760/184/DPUK/V/2<strong>01</strong>1 Kepala Dinas PU Kab. Bulungan 09/09/11 12/10/11 16198911700071199 19/05/2<strong>01</strong>1 77/IV/Ro III/UM/12/10Kepala Biro Keuangan dan Perlengkapan SetjendKementerian Perhubungan<strong>01</strong>/07/11 12/10/11 16198913000081200 19/05/2<strong>01</strong>1 120/AU.2/V/AKPAR-2<strong>01</strong>1 Direktur Akademi Pariwisata Negeri Medan 09/09/11 12/10/11 16198911100<strong>03</strong>12<strong>01</strong> 19/05/2<strong>01</strong>1 A.3/523.000/180/V/2<strong>01</strong>1Pembina Tk. I Dinas Kelautan dan Perikanan PemkabKutai Kartanegara1202 20/05/2<strong>01</strong>1 S-338/BC.1/UP.6/2<strong>01</strong>1 Sekretaris Ditjend Bea Cukai Kementerian Keuangan 09/09/11 13/10/11 1619892480006Sertifikat masih berlaku dansudah lulus ujian12<strong>03</strong> 20/05/2<strong>01</strong>1 810/175 Kepala Dinas PU Kab. Manokwari 09/09/11 12/10/11 16198911300<strong>01</strong>Hal 59

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1204 20/05/2<strong>01</strong>1 PH.346/<strong>01</strong>/02/UPP.MGR-11Kepala Kantor UPP Kelas I Manggar DitjendPerhubungan Laut KemhubPj. Kepala KPP Pratama Jakarta Kebon Jeruk Satu,1205 20/05/2<strong>01</strong>1 S-92/WPJ.05/KP.07<strong>01</strong>/2<strong>01</strong>1 Kanwil DJP Jakarta Barat, Ditjend Pajak Kementerian1206 20/05/2<strong>01</strong>1 PL.102/1/14/DJPD/2<strong>01</strong>1KeuanganDirektur Lalu Lintas dan Angkutan Sungai, Danau danPenyebrangan, Ditjend Perhubungan Darat, Kemhub12/10/11 16198912600051207 20/05/2<strong>01</strong>1 S-421/WBC.04/PS/2<strong>01</strong>1Kepala Pangkalan Sarana Operasi Bea dan CukaiTanjung Balai Karimun27/10/11 04/11/11 16823552200061208 20/05/2<strong>01</strong>1 <strong>027</strong>/1270/PEMB Wakil Walikota Palu 12/10/11 1619891190005Sudah pernah diajukankonversiTidak ada fotocopysertifikat1209 23/05/2<strong>01</strong>1 025/405/Dikmen-2<strong>01</strong>1 Dinas Pendidikan dan Olahraga Sumatera Barat Persyaratan tidak lengkap1210 23/05/2<strong>01</strong>1 PH.349/1/2/Kpl-Tjt-11Kementrian Perhubungan DIRJEN Perhubungan LautTanjung Batu Kundur09/08/11 13/10/11 16198910800091211 23/05/2<strong>01</strong>1 KP.06.02.O.MKS/LA.252 Kementrian PU DIRJEN Bina Marga Sulawesi Selatan 09/08/11 11/10/11 16198904400021212 23/05/2<strong>01</strong>1 050/307/416-202.F/2<strong>01</strong>1 BAPPEDA Mojokerto 09/08/11 11/10/11 161989060000<strong>01</strong>213 23/05/2<strong>01</strong>1 602.1/ / DBMPSDA1214 23/05/2<strong>01</strong>1 PM.<strong>01</strong>18/V.3/338/2<strong>01</strong>1Dinas Bina Marga dan Pengelolaan Sumber Daya AirBekasiDIRJEN Pengendalian Penyakit dan PenyehatanLingkungan Kementrian Kesehatan RI09/08/11 12/10/11 161989223000709/08/11 13/10/11 161989107000<strong>01</strong>215 23/05/2<strong>01</strong>1 S-519/WKN.12/KNL.<strong>03</strong>/2<strong>01</strong>1Kementrian Keuangan RI DIRJEN Kekayaan NegaraBanjarmasin09/08/11 13/10/11 16198925800<strong>03</strong>Sama dengan <strong>No</strong>. Surat S-519/WKN.12/KNL.<strong>03</strong>/2<strong>01</strong>11216 23/05/2<strong>01</strong>1 S.132/BPKH.X-1/2<strong>01</strong>1 Kementrian Kehutanan DIRJEN Planologi Kehutanan Sudah lulus ujian1217 23/05/2<strong>01</strong>1 870/222/DPU-KB/V/2<strong>01</strong>1 PEMKAB Kutai Barat Dinas PU dan Kimpraswil1218 23/05/2<strong>01</strong>1 800/1682/Dalprog SEKDA Kab. Kerawang 09/08/11 13/10/11 1619891050002Sertifikat sudah pernahdikonversi1219 24/05/2<strong>01</strong>1 602.1/55/v/2<strong>01</strong>1 kePALA kaNTOR Penghubung Pemerintah Aceh 09/08/11 10/10/11 16198908000041220 24/05/2<strong>01</strong>1 S.220/Keu-3/2<strong>01</strong>1Kepala Biro Keuangan Setjend KementerianKehutanan09/08/11 17/10/11 16198932000091221 24/05/2<strong>01</strong>1 800/147/BLH.V/2<strong>01</strong>1 Kepala Badan Lingkungan Hidup Kota Bengkulu 09/08/11 13/10/11 16198925700041222 24/05/2<strong>01</strong>1 600/040/D-PU.CK Kepala Dinas PU Kota Pontianak 09/08/11 13/10/11 16198909600051223 24/05/2<strong>01</strong>1 893.3/1346/411.3<strong>03</strong>/2<strong>01</strong>1 Plt. Kepala BKD Kabupaten Nganjuk 09/08/11 22/09/11 1619887390006Berkas digabung dengan<strong>No</strong>. Surat893.3/9<strong>01</strong>/411.3<strong>03</strong>/2<strong>01</strong>11224 24/05/2<strong>01</strong>1 1751.0435 Kepala BPS Provinsi Bengkulu Sertifkat masih berlaku1225 24/05/2<strong>01</strong>1 PD <strong>01</strong><strong>01</strong>-Is/943 Sekretrais Inspektorat Jenderal Kementerian PU 09/08/11 12/10/11 1619892320005Hal 60

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1226 24/05/2<strong>01</strong>1 S-2244/SU02/1/2<strong>01</strong>1 Kepala Biro Kepegawaian dan Organisasi BPKP 09/08/11 11/10/11 16198905800051227 24/05/2<strong>01</strong>1 600/135/B.5 Bupati Bengkulu Selatan 09/08/11 13/10/11 16198924300<strong>01</strong>1228 24/05/2<strong>01</strong>1 2521/IPH-1/KP/IV/2<strong>01</strong>1 Kepla Pusat Penelitian Biologi - LIPI 09/08/11 13/10/11 16198910900081229 24/05/2<strong>01</strong>1 800/302/III/2<strong>01</strong>1/pemb Bupati Kepulauan Selayar 09/08/11 13/10/11 16198910600<strong>01</strong>1230 24/05/2<strong>01</strong>1 420/215/BPMPD/2<strong>01</strong>1Kepala Badan Pemberdayaan Masyarakat danPemerintahan Desa Kab. Kotabaru09/08/11 12/10/11 16198922400061231 24/05/2<strong>01</strong>1 UM.002/B.110/V/PIP.Smg-11 Direktur Politeknik Ilmu Pelayaran Semarang 09/08/11 13/10/11 16198909600051232 24/05/2<strong>01</strong>1 270/48 Sekretrais Komisi Pemilihan Umum Kab. Semarang 09/08/11 12/10/11 16198922700<strong>03</strong>1233 25/05/2<strong>01</strong>1 W8-A/6208PP.00/V/2<strong>01</strong>1 Ketua Pengadilan Tinggi Agama Bandar LAMpungSertifikat masih berlaku danTidak ada sosialisasi perpres541234 25/05/2<strong>01</strong>1 050/08749/2<strong>01</strong>1 Gubernur Jawa Tengah 09/08/11 12/10/11 16198923100061235 25/05/2<strong>01</strong>1 800/1092/425.<strong>03</strong>2/2<strong>01</strong>1 Walikota Probolinggo 09/08/11 13/10/11 16198926100071236 25/05/2<strong>01</strong>1 S-4210/WBC.10/KPP.MP.<strong>01</strong>/2<strong>01</strong>1Kepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe Madya Pabean Tanjung Perak Kanwil Jatim 09/08/11 11/10/11 16198906700<strong>03</strong>1237 25/05/2<strong>01</strong>1 Kw.32.1/HM.<strong>01</strong>/2106/2<strong>01</strong>1I Ditjen Bea dan Cukai Kementerian KeuanganKepala Kanwil Prov. Kepulauan Riau KementerianAgama10/08/11 12/10/11 16198910400<strong>03</strong>1238 25/05/2<strong>01</strong>1 <strong>027</strong>/4275/2<strong>01</strong>1Bupati Aceh Timur, Sekretariat Daerah Pemkab AcehTimur1239 25/05/2<strong>01</strong>1 800/918/2<strong>01</strong>1Kepala Dinas Pengelola Keuangan dan KekayaanDaerah Kab. Aceh Timur10/08/11 10/10/11 16198902000021240 25/05/2<strong>01</strong>1 <strong>01</strong>3/ULP/2<strong>01</strong>1 Kepala ULP Kab. Aceh Timur 10/08/11 14/10/11 161989282000<strong>01</strong>241 25/05/2<strong>01</strong>1 523/699/2<strong>01</strong>1Kepala Dinas Kelautan dan Perikanan Pemkab AcehTamiangSertifikat sudah pernahdiajukan konversiSertifikat Masih Berlaku1242 25/05/2<strong>01</strong>1 600/1062 Kepala Dinas PU Pemkab Aceh Tamiang Sertifikat Masih Berlaku1243 25/05/2<strong>01</strong>1 800/744/2<strong>01</strong>1 RSUD dr. Fauziah Pemkab Bireun 19/10/11 02‐11‐2<strong>01</strong>1 16198941400071244 25/05/2<strong>01</strong>1 810/13461245 25/05/2<strong>01</strong>1 524/838/2<strong>01</strong>11246 25/05/2<strong>01</strong>1 800/465/2<strong>01</strong>11247 25/05/2<strong>01</strong>1 255/893.3/2<strong>01</strong>1Kepala Dinas Kehutanan dan Perkebunan PemkabAceh TimurKepala Dinas Peternakan dan Kesehatan Hewan Kab.Aceh TimurKepala Badan Lingkungan Hidup, Kebersihan danPemadam KebakaranKepala Dinas Perhubungan Komunikasi danInformatika21/10/11 02‐11‐2<strong>01</strong>1 161989428000<strong>03</strong>0/09/11 10/10/11 16198902100<strong>01</strong>19/10/11 02‐11‐2<strong>01</strong>1 161989419000219/10/11 02‐11‐2<strong>01</strong>1 16198941800<strong>03</strong>Hal 61

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1248 25/05/2<strong>01</strong>1 893.3/8651249 25/05/2<strong>01</strong>1 893/652/2<strong>01</strong>11250 25/05/2<strong>01</strong>1 In.<strong>01</strong>./Ku.<strong>01</strong>/1178/2<strong>01</strong>11251 25/05/2<strong>01</strong>1 2177/PL.210/J.1/5/11Kepala Badan Perencanaan Pembangunan Daerah Kab.Aceh TimurKepala Badan Pemberdayaan Masyarakat, Perempuandan Keluarga Sejahtera Kab. Aceh TimurKepala Biro AUAK IAIN Ar-Raniry Darussalam -Banda AcehSekretaris Badan Penyuluhan dan Pengembangan SDMPertanian Kementerian Pertanian30/09/11 10/10/11 16198908100<strong>03</strong>30/09/11 10/10/11 16198902200<strong>01</strong>0/08/11 12/10/11 1619892280002Sertifikat Masih Berlaku1252 25/05/2<strong>01</strong>1 UM.<strong>01</strong> <strong>01</strong>-Le07/19Kepala Balai Penelitian dan Pengembangan SosialEkonomi Lingkungan Bidang Jalan dan JembatanPuslitbang Sosial Ekonomi dan Lingkungan BalitbangKementerian PUSudah lulus ujian dansertifikat sudah pernahdikonversi1253 25/05/2<strong>01</strong>1 - an Yansenes 10/08/11 13/10/11 1619891<strong>01</strong>00061254 25/05/2<strong>01</strong>1 800/14677/V/2<strong>01</strong>1 Direktur RSUD Kota Padangsidimpuan 10/08/11 12/10/11 16198912400071255 26/05/2<strong>01</strong>1 900/238/404.3.12/2<strong>01</strong>1 Kepala Dinas PU Bina Marga Pemkab Sidoarjo 10/08/11 13/10/11 16198909900021256 26/05/2<strong>01</strong>1 117/084 Camat Mampang Prapatan 10/08/11 13/10/11 16198909800<strong>03</strong>Asisten Kapolri Bidang Sarana dan Prasarana1257 26/05/2<strong>01</strong>1 B/881/V/2<strong>01</strong>1/Ssarpras10/08/11 13/10/11 1619892600008Mabespolri1258 26/05/2<strong>01</strong>1 897.2/1718/PUK-SEKRET/2<strong>01</strong>1 Kepala Dinas PU Pemkab Nias Sertifikat Masih Berlaku1259 26/05/2<strong>01</strong>1 W9-PR.<strong>01</strong>.02-240Kepala Kantor Wilayah Jawa Tengah KementerianHukum dan HAM1260 26/05/2<strong>01</strong>1 <strong>027</strong>/297/Pemb. Sekretaris Daerah Kabupaten Paser 15/07/11 12/10/11 16198923000071261 26/05/2<strong>01</strong>1 Sti.28/<strong>03</strong>/KP.<strong>01</strong>.2/1341/2<strong>01</strong>1 Ketua STAIN Tulungagung 15/07/11 11/10/11 16198906200081262 26/05/2<strong>01</strong>1 63/IAPI/SP/V/2<strong>01</strong>1 Wasekjend DPP IAPI 10/08/11 13/10/111263 26/05/2<strong>01</strong>1 62/IAPI/SP/V/2<strong>01</strong>1 Wasekjend DPP IAPI 10/08/11 13/10/111264 26/05/2<strong>01</strong>1 64/IAPI/SP/V/2<strong>01</strong>1 Wasekjend DPP IAPI 10/08/11 13/10/111265 26/05/2<strong>01</strong>1 505/527/BangSekretaris Daerah Kota Jambi Ub. Asisten AdministrasiUmum10/08/11 13/10/11 16198925900021266 26/05/2<strong>01</strong>1 213/J30/LL/2<strong>01</strong>1 Kepala LPMP Prov. Jawa Tengah, Kemdiknas 10/08/11 13/10/11 16198924000041267 26/05/2<strong>01</strong>1 420/6824/022/2<strong>01</strong>1Kepala Biro Administrasi Pembangunan SetdaPemprov. Jatim10/08/11 14/10/11 16198929500041268 26/05/2<strong>01</strong>1 05/H5.2.3.2/PPM/2<strong>01</strong>1 Ketua LPM Suniversitas Sumatera Utara Kemdiknas 10/08/11 14/10/11 16198927900061269 26/05/2<strong>01</strong>1 361/J18.1/2<strong>01</strong>1 Kepala LPMP Prov. NAD Kemdiknas 09/09/11 12/10/11 16198922900<strong>01</strong>Sertifikat Masih BerlakuHal 62

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1270 27/05/2<strong>01</strong>1 <strong>01</strong>.<strong>01</strong>/319/ULP/IV/2<strong>01</strong>1 Sekretaris Daerah Pemkab Lampung Tengah 10/08/11 12/10/11 16198912700041271 27/05/2<strong>01</strong>1 222/DPP-SEK/V/2<strong>01</strong>11272 27/05/2<strong>01</strong>1 050/1002/407.206/2<strong>01</strong>1Kepala Dinas Perindustrian dan Perdagangan Prov.Kepulauan RiauWadir Umum & Keuangan RSUD Dr. IskakTulungagung15/07/11 10/10/11 1619889890009Sudah lulus ujian1273 27/05/2<strong>01</strong>1 424/1020/14.08/2<strong>01</strong>1 Kepala SMK NU M'arif Kudus Sertifikat masih berlaku1274 27/05/2<strong>01</strong>1 <strong>027</strong>/<strong>01</strong>25/Bag.Adm.Pemb dan SDA Sekretaris Daerah Pemkab Donggala Persyaratan tidak lengkap1275 27/05/2<strong>01</strong>1 800/116/2<strong>01</strong>1 Direktur RSU Kardinah 15/07/11 13/10/11 16198925600051276 27/05/2<strong>01</strong>1 S.155/BL-3/2<strong>01</strong>11277 30/05/2<strong>01</strong>1 800/333/2<strong>01</strong>11278 30/05/2<strong>01</strong>1 -Kepala Pusat Pengembangan Penyuluhan Kehutanan,Badan Penyuluhan dan Pengembangan SDMKehutanan, KemhutKepala Dinas Kelautan, Perikanan dan Pertanian KotaLhokseumaweKepala Dinas Pendapatan Pengelolaan Keuangan danAset Daerah Kab. Bolaang Mongondow Utara15/07/11 13/10/11 1619891<strong>03</strong>000415/07/11 10/10/11 1619889880000Persyaratan tidak lengkap1279 30/05/2<strong>01</strong>1 800/Pem/243/III/2<strong>01</strong>1 Bupati Pohuwato 15/07/11 13/10/11 16198924000041280 30/05/2<strong>01</strong>1 090/UN33.9/PM/2<strong>01</strong>1 Sekretaris LPM Universitas Negeri Medan 15/07/11 19/08/11 16198922900<strong>01</strong>1281 30/05/2<strong>01</strong>1 500/Setda-KK/07/35/V/2<strong>01</strong>1 Plt. Sekretaris Daerah Pemkot Kotamobagu 15/07/11 13/10/11 16198923900081282 30/05/2<strong>01</strong>1 B/1098/V/2<strong>01</strong>1/Lemdikpol Karo Renmin Mabes POLRI 15/07/11 04/10/11 16198879900081283 30/05/2<strong>01</strong>1 SM.307/ /<strong>01</strong>/Dv/CLP-11 Kepala Distrik Navigasi Kelas III Cilacap 15/07/11 13/10/11 16198909700041284 30/05/2<strong>01</strong>1 Kd.16.06/1/HM.00/414/2<strong>01</strong>11285 30/05/2<strong>01</strong>1 094/1490/Sikpora-AKepla Kantor Kabupaten Kutai Barat, KementerianAgamaKepala Dinas Pendidikan dan Olahraga KabupatenSanggau1286 30/05/2<strong>01</strong>1 043/368/ADPEMB Sekretaris Daerah Kota Tanjungpinang 15/09/11 17/10/11 1619893210008Tidak ada sosialisasi perpres54Sertifikat masih berlaku1287 30/05/2<strong>01</strong>1 900/282/PMPDPP&KB/2<strong>01</strong>1 Kepala Badan PMPDPP&KB Kab. Kerinci 15/09/11 17/10/11 16198932500041288 30/05/2<strong>01</strong>1 602/16405 Sekretaris Daerah Pemerintah Aceh Persyaratan tidak lengkap1289 30/05/2<strong>01</strong>1 W.29-U/950/KP.<strong>01</strong>.02/V/2<strong>01</strong>1 Wakil Ketua Pengadilan Tinggi Banten 09/09/11 14/10/11 16198929300061290 30/05/2<strong>01</strong>1 W27-A/676/KP.<strong>01</strong>.2/IV/2<strong>01</strong>1 Panitera/Sekretaris Pengadilan Tinggi Agama Banten <strong>01</strong>/07/11 14/10/11 16198931400081291 30/05/2<strong>01</strong>1 S.210/DAR-4/2<strong>01</strong>1Kepala Pusat Standardisasi dan Lingkungan,Kementerian Kehutanan05/08/11 14/10/11 1619892940005Hal 63

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1314 06/06/2<strong>01</strong>1 045.2/187/Dalbang.2<strong>01</strong>1Kepala Bagian Pengendalian Pembangunan SetdaPemkot Banjarmasin05/08/11 13/10/11 16198927200<strong>03</strong>1315 06/06/2<strong>01</strong>1 B/3090/PEG/5/2<strong>01</strong>1Kabiro Kepegawaian Badan Pengusahaan KawasanPerdagangan Bebas dab Pelabuhan Bebas Batam13/10/11 28/10/11 16198921500081316 06/06/2<strong>01</strong>1 800/1647/416-115/2<strong>01</strong>1 Plt. Sekretaris Daerah Pemkab Mojokerto Persyaratan tidak lengkap1317 06/06/2<strong>01</strong>1 050/321/430.811/2<strong>01</strong>1Pj. Kepala Dinas Bina Marga dan Cipta Karya Kab.Bondowoso1318 06/06/2<strong>01</strong>1 UM <strong>01</strong> <strong>03</strong>-CL/247Direktur Pengembangan Penyehatan LingkunganPermukiman, Ditjend Cipta Karya Kem. PU1319 06/06/2<strong>01</strong>1 B.II/2/Kp.02/07550/2<strong>01</strong>1 Kepala Biro Kepegawaian Setjend Kementerian Agama09/09/11 13/10/11 161989244000007/11/11 23/11/11 16823579000051320 06/06/2<strong>01</strong>1 25/DST/PLP/V/2<strong>01</strong>1 Corporate Manager Diponegoro Smart Solution 09/09/11 13/10/11 16198925400071321 06/06/2<strong>01</strong>1 600/118/Bang/2<strong>01</strong>1 Sekretaris Daerah Pemkab Kotawaringin Barat 14/10/11 26/10/11 1619894110000Tidak ada sosialisasi perpres541322 06/06/2<strong>01</strong>1 S.179/SMKHUT-1/2<strong>01</strong>11323 06/06/2<strong>01</strong>1 S.346/BPTH.Sul-1/2<strong>01</strong>1Plh. Kepala SMK Kehutanan Makassar, BPPSDMKehutanan, Kementerian KehutananKepala Balai Perbenihan Tanaman Hutan Sulawesi,Ditjend Bina Pengelolaan DAS dan Perhutanan Sosial ,Kemhut09/09/11 13/10/11 161989253000809/09/11 13/10/11 16198927700081324 06/06/2<strong>01</strong>1 <strong>027</strong>/043/Setda-ULP/2<strong>01</strong>1 Kepala ULP Setda Pemkab Tanah Bumbu 09/09/11 13/10/11 16198927600091325 06/06/2<strong>01</strong>1 7<strong>01</strong>/74.12/SDE/2<strong>01</strong>11326 06/06/2<strong>01</strong>1 S-436/WBC.02/KPP.04/2<strong>01</strong>1Sekretaris Ditjend Energi Baru, TERbarukan, danKonservasi Energi Kem. ESDMKepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe B Sibolga Kanwil Sumut, Ditjen Bea danCukai Kem. Keu09/09/11 13/10/11 1619892540007Tidak ada fotocopysertifikat1327 07/06/2<strong>01</strong>1 050/106/Bappeda/2<strong>01</strong>1 Kepala Bappeda Pemkab Tanah Bumbu Sudah lulus ujian1328 07/06/2<strong>01</strong>1 272/BP2MPD-ULP/V/2<strong>01</strong>1 Kepala ULP Kab. Indragiri Hilir Persyaratan tidak lengkap1329 07/06/2<strong>01</strong>1 816/3381-Sekret.Disdik Kepala Dinas Pendidikan Prov. Jawa Barat 09/09/11 13/10/11 16198924900051330 07/06/2<strong>01</strong>1 800/1584/25/2<strong>01</strong>1 Sekretaris Daerah Kota Bandar Lampung 09/09/11 13/10/11 16198924200021331 07/06/2<strong>01</strong>1 B.563/BBPLKDN/V/2<strong>01</strong>1Balai Besar Pengembangan Latihan Kerja DalamNegeri, Ditjend Pembinaan Pelatihan danProduktivitas, Kemnakertrans09/09/11 13/10/11 16198923400<strong>03</strong>1332 07/06/2<strong>01</strong>1 <strong>01</strong>1/PRY/S-PBJ/Unand/2<strong>01</strong>1 Pembantu Rektor II Universitas Andalas 09/09/11 12/10/11 16198911500091333 07/06/2<strong>01</strong>1 425/635/SMK1334 07/06/2<strong>01</strong>1 671/1190-BE/DistambenKepala SMKN 1 Kedawung Dinas Pendidikan PemkabCirebonKepala Dinas Pertambangan dan Energi Prov.Kalimantan Selatan15/07/11 12/10/11 1619891160008Sertifikat masih berlakuHal 65

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1335 07/06/2<strong>01</strong>1 800/129/413.023/2<strong>01</strong>0 Plt. Sekretaris Daerah Pemkab Lamongan 15/07/11 17/10/11 16198931900<strong>03</strong>1336 07/06/2<strong>01</strong>1 Un.<strong>01</strong>/R/KS.<strong>01</strong>.6/843/2<strong>01</strong>1 KPA UIN Syarif Hidayatullah Jakarta 15/07/11 14/10/11 16198928400081337 08/06/2<strong>01</strong>1 88/DESDM.540/06.11Kepala Dinas Energi dan SDM Kab. KepulauanAnambas15/07/11 13/10/11 16198926700<strong>01</strong>1338 08/06/2<strong>01</strong>1 050/1230/V/2<strong>01</strong>1 Plt. Kepala Bappeda Kab. Pakpak Bharat 15/07/11 13/10/11 16198927800071339 08/06/2<strong>01</strong>1 347.1/SJ-IND.3/5/2<strong>01</strong>1Kepala Biro Keuangan Setjend KementerianPerindustrian15/07/11 14/10/11 16198928500071340 08/06/2<strong>01</strong>1 Set.IJ/4/OT.OC/<strong>01</strong>44/2<strong>01</strong>1 Sekretaris Inspektorat Jenderal Kementerian Agama 09/09/11 14/10/11 16198928300091341 08/06/2<strong>01</strong>1 500/660/B.VIII/KK/2<strong>01</strong>1 Sekretrais Daerah Pemkab Kaur 15/07/11 14/10/11 16198928700051342 08/06/2<strong>01</strong>1 130.04/83/Depem/2<strong>01</strong>1 Sekretaris Daerah Kabupaten Lombok Timur 09/09/11 14/10/11 16198928000021343 08/06/2<strong>01</strong>1 602.1-126/Adm.Pemb/V/2<strong>01</strong>1Kepala Biro Administrasi Pembangunan SetdaPemprov. Maluku1344 08/06/2<strong>01</strong>1 11399/H4.2/UM.10/2<strong>01</strong>1 Wakil Rektor II Universitas Hasanuddin 15/09/11 17/10/11 16198928800041345 08/06/2<strong>01</strong>1 800/151/D.HubkomKepala Dinas Perhubungan, Komunikasi danInformatika Prov. Sulawesi Utara15/09/11 14/10/11 16198930900061346 08/06/2<strong>01</strong>1 W9-PR.<strong>01</strong>.02-267 Kepala Kantor Wilayah Jawa Tengah Kemhukham <strong>01</strong>/11/11 11/11/11 16823560800051347 08/06/2<strong>01</strong>1 045/262/Hutbun/V/2<strong>01</strong>1Kepala Dinas Kehutanan dan Perkebunan PemkabSoppeng15/09/11 13/10/11 161989275000<strong>01</strong>348 08/06/2<strong>01</strong>1 800/1824/419.62/2<strong>01</strong>1 Kepala Badan Kepegawaian Daerah Kota Kediri 15/09/11 14/10/11 1619892860006Sertifikat masih berlaku1349 08/06/2<strong>01</strong>1 900/384/sosnakertrans/2<strong>01</strong>1 Kepala Dinas sosnakertrans 10/10/11 14/10/11 16198928300091350 09/06/2<strong>01</strong>1 B/731/VI/2<strong>01</strong>1 Wakil Direktur Peralatan, MabesAD 15/09/11 14/10/11 161989299000<strong>01</strong>351 09/06/2<strong>01</strong>1 602/40/P.1/BAPKR-2<strong>01</strong>1Kepala Biro Administrasi Pembangunan danKerjasama Rantau, Setda Pemprov. Sumatera Barat15/09/11 13/10/11 16198923600<strong>01</strong>1352 09/06/2<strong>01</strong>1 050/1771/4<strong>01</strong>.<strong>01</strong>2/2<strong>01</strong>1Asisten Pemerintahan dan Pembangunan SekretariatDaerah Pemkot Madiun21/10/11 02‐11‐2<strong>01</strong>1 16823553600091353 09/06/2<strong>01</strong>1 <strong>027</strong>/489/I-3/Dinsos Kepala Dinas Sosial Prov. Sumatera Selatan 17/10/11 24/10/11 161989466000<strong>01</strong>354 09/06/2<strong>01</strong>1 S.74/SMK.Hut.1/2<strong>01</strong>11355 10/06/2<strong>01</strong>1 420/7279/022/2<strong>01</strong>11356 10/06/2<strong>01</strong>1 523.900/912/178/Dislutkan1357 10/06/2<strong>01</strong>1 050/247/BPPA-KB/2<strong>01</strong>1Kepala SMK Kehutanan Manokwari BPPSDMKehutanan Kementerian KehutananKepala Bagian Pengembangan Program SetdaPemprov. JatimSekretaris Dinas Kelautan dan Perikanan PemkabBanggaiKepala Badan Pemberdayaan Perempuan Anak dan KBKab. Katingan17/10/11 18/10/11 161989275000<strong>01</strong>7/10/11 24/10/11 161989390000817/10/11 28/10/11 1619892200000<strong>03</strong>/11/11 14/11/11 1682356370007Hal 66

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1358 10/06/2<strong>01</strong>1 602/2179Kepala Bagian Administrasi Pembangunan SetdaPemkab Bantul24/<strong>01</strong>/11 04/11/11 16823551000<strong>01</strong>1359 10/06/2<strong>01</strong>1 <strong>027</strong>/766 Sekretaris Daerah Pemkot Salatiga 23/11/11 07‐12‐2<strong>01</strong>1 1682362<strong>01</strong>00<strong>03</strong>1360 10/06/2<strong>01</strong>1 020/322/Dalbang-2<strong>01</strong>1 Plt. Setda Pemkab Tanah Datar 12/10/11 20/10/11 161989480000<strong>01</strong>361 10/06/2<strong>01</strong>1 4040/SJ-DAG.9.4/SD/6/2<strong>01</strong>1 Kepala Pusat Pengawasan Mutu Barang 12/10/11 19/10/11 16198936100061362 10/06/2<strong>01</strong>1 734/-077 Kepala Dinas PU Prov. DKI Jakarta <strong>03</strong>/11/11 04/11/11 16823552300051363 10/06/2<strong>01</strong>1 024.2/1641/2<strong>01</strong>1Asisten Bidang Ekonomi, Pembangunan danLingkungan hidup Setda Pemkab Purworejo12/10/11 24/10/11 16198949100061364 10/06/2<strong>01</strong>1 600/941/EKBANG-B Sekretaris Daerah Pemkab Kayong Utara 12/10/11 28/10/11 16198945400051365 10/06/2<strong>01</strong>1 800/284/V/Peg Sekretaris Dinas PU Prov. Kalimantan Tengah 02/11/11 06‐12‐2<strong>01</strong>1 16823613500<strong>01</strong>1366 10/06/2<strong>01</strong>1 B/141/VI/2<strong>01</strong>1/BNN Sekretaris Utama Badan Narkotika Nasional (BNN) 14/10/11 19/10/11 16198936500021367 10/06/2<strong>01</strong>1 560/967/Sosnakertrans-AKepala Dinas Sosial Tenaga Kerja dan TransmigrasiKab. Pontianak10/10/11 13/10/11 161498927300021368 10/06/2<strong>01</strong>1 SM.107/ADBAN.402/V/2<strong>01</strong>1Kepala Kantor Administrator Bandar Udara PoloniaMedan10/10/11 14/10/11 16198929700021369 10/06/2<strong>01</strong>1 B/1461/VI/2<strong>01</strong>1/BNN Plt. Inspektur Utama Badan Narkotika Nasional (BNN) 19/09/11 19/10/11 16198936500021370 10/06/2<strong>01</strong>1 DL.107/8/13/SEKJEN/KKP/2<strong>01</strong>1Sekretaris Jenderal Kementerian Kebudayaan danPAriwisata1371 10/06/2<strong>01</strong>1 600/48/Bang-ULP/2<strong>01</strong>1 Kepala ULP Kab. Balangan 14/10/11 24/10/11 16198940200021372 13/06/2<strong>01</strong>1 S-521/WPB.20/KP.0510/2<strong>01</strong>1Pj. Kepala Kantor Pelayanan Perbendaharaan NegaraKanwil Prov. Kaltim - Nunukan1373 13/06/2<strong>01</strong>1 <strong>027</strong>/184/Umkap/III/2<strong>01</strong>1Kepala Bagian Umum dan Perlengkapan Setda Kab.Tanah Bumbu10/10/11 14/10/11 16198929800<strong>01</strong>1374 13/06/2<strong>01</strong>1 W13-U5/1265/HM.<strong>01</strong>/VI/2<strong>01</strong>1 Panitera/Sekretrais Pengadilan Negeri Bantul 10/10/11 13/10/11 1619891000007Sama dengan <strong>No</strong>. SuratB/141/VI/2<strong>01</strong>1/BNNTidak ada sosialisasi perpres54Sertifikat masih berlaku1375 13/06/2<strong>01</strong>1 050.1/270.b/IV.02/MSJ/2<strong>01</strong>1 Kepala Bappeda Kab. Mesuji 17/10/11 26/10/11 16198941000<strong>01</strong>1376 13/06/2<strong>01</strong>1 STI.041/KP.02.3/1772/2<strong>01</strong>1 Ketua STAIN Sjech M. Djamil Djambek BukittinggiSertifikat masih berlaku danTidak ada sosialisasi perpres541377 13/06/2<strong>01</strong>1 931.1/FTP-UGM/KP/2<strong>01</strong>1 Kepala Kantor Administrasi FTP Univ. Gajahmada 29/09/11 04/10/11 16198924700071378 13/06/2<strong>01</strong>1 06/LPPN/VI/2<strong>01</strong>11379 13/06/2<strong>01</strong>1 463-1/ITJ.0/KP.150/VI/2<strong>01</strong>11380 13/06/2<strong>01</strong>1 Kd.17.09/1/OT.00/221/2<strong>01</strong>1Direktur Program Lembaga PengembanganPengetahuan Nusantara (LPPN)Sekretaris Inspektorat Jenderal Kementerian Kelautandan PerikananKepala Kantor Kabupaten Tabalong KementerianAgama17/10/11 24/10/11 161989391000710/10/11 13/10/11 161989237000<strong>01</strong>0/10/11 13/10/11 1619892470007Hal 67

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1381 13/06/2<strong>01</strong>1 B/1473/VI/2<strong>01</strong>1/BNN Sekretaris Utama Badan Narkotika Nasional (BNN) 11/10/11 19/10/11 16198936500021382 13/06/2<strong>01</strong>1 050/BPPDPM-TU/129Kepala Badan Perencanaan Pembangunan Daerah danPenanaman Modal Pemkab Lingga10/10/11 14/10/11 16198929600<strong>03</strong>1383 13/06/2<strong>01</strong>1 120.04/134Kepala Balai Pemberdayaan dan Pengawasan JasaKonstruksi Dincipkataru Pemprov Jawa Tengah17/10/11 20/10/11 16198949600<strong>01</strong>1384 13/06/2<strong>01</strong>1 200/307/2<strong>01</strong>1 Kepala Dinas Bina Marga Kab. Aceh Utara 12/10/11 19/10/11 1619893470006Sama dengan <strong>No</strong>. SuratB/141/VI/2<strong>01</strong>1/BNN1385 13/06/2<strong>01</strong>1 800/1755/Peg/VI/2<strong>01</strong>1 Plt. Kepala Dinas Kesehatan Kab. Nias Selatan 12/10/11 19/10/11 16198936600<strong>01</strong>1386 14/06/2<strong>01</strong>1 Kd.21.10/1-c/KS.<strong>01</strong>.2/657/2<strong>01</strong>1 Kepala Kantor Kab. Sinjai Kementerian Agama1387 14/06/2<strong>01</strong>1 162/UPT LAGG/BPPT/VI/2<strong>01</strong>1Kepala UPT-Laboratorium Aero Gasdinamika danGetaran - BPPT12/10/11 19/10/11 16198935500051388 14/06/2<strong>01</strong>1 B.360/1313/RR-BPBD/2<strong>01</strong>1Kepala Bidang Rehabilitasi dan Rekonstruksi BPBDPemprov. Sumbar10/10/11 13/10/11 16198925200091389 14/06/2<strong>01</strong>1 020/243/P-2/V/2<strong>01</strong>1Kepala Bagian Perlengkapan Setda Pemkab KutaiKartanegara12/10/11 19/10/11 16198934500081390 15/06/2<strong>01</strong>1 436/-1.712.8 Dirut PD. PAL JAYA 10/10/11 13/10/11 1619892510000Tidak ada sosialisasi perpres541391 15/06/2<strong>01</strong>1 <strong>027</strong>/335/Pemb/2<strong>01</strong>1 Sekretaris Daerah Pemkab Lombok Utara 14/10/11 26/10/11 16198937200021392 15/06/2<strong>01</strong>1 22/Bld.1/Umum/S/VI/2<strong>01</strong>1Kepala Bagian Umum Badan Litbang Diklat Hukumdan Peradilan Mahkamah Agung RI1393 15/06/2<strong>01</strong>1 870/573/BAP Sekretaris Daerah Pemkab Muaro Jambi10/10/11 13/10/11 16198924600081394 15/06/2<strong>01</strong>1 893.3/453/SET.RENMON Kepala Dinas PU Prov. Kalimantan Barat 14/10/11 31/10/11 16198920200041395 15/06/2<strong>01</strong>1 598/C2/LK/2<strong>01</strong>1Direktur Pembinaan Sekolah Dasar Ditjend PendidikanDasar Kemdiknas1396 15/06/2<strong>01</strong>1 W10-A/1542/PL.04/VI/2<strong>01</strong>1 Ketua Pengadilan Tinggi Agama Bandung 10/10/11 13/10/11 16198926600021397 15/06/2<strong>01</strong>1 <strong>027</strong>/1635/Skrt/DistanakKepala Dinas Pertanian dan Peternakan PemkabBuleleng02/11/11 14/11/11 16823563500091398 15/06/2<strong>01</strong>1 179/PEN.5/6/2<strong>01</strong>1 Direktur Pengembangan Promosi dan Citra <strong>01</strong>/11/11 09‐11‐2<strong>01</strong>1 16823558200081399 16/06/2<strong>01</strong>1 <strong>027</strong>/02Kepala Bidang Perencanaan dan PengendalianOperasional Pendapatan Pemkot Tegal1400 16/06/2<strong>01</strong>1 B-23/R.4.1/Cu.3/06/2<strong>01</strong>1 Wakil Kepala Kejaksaan Tinggi Sulawesi Selatan 10/10/11 14/10/11 161989312000<strong>01</strong>4<strong>01</strong> 16/06/2<strong>01</strong>1 <strong>027</strong>/1185/Pemb.Asisten Sekda Bidang Perekonomian danPembangunan Setda Pemkab Purwakarta14/10/11 28/10/11 16198945300061402 16/06/2<strong>01</strong>1 045.2/1998/D-Kes/Prc/2<strong>01</strong>1 Kepala Dinas Kesehatan Kota Pontianak 14/10/11 24/10/11 1619894900007Sama dengan <strong>No</strong>. Surat870/259/BAPSertifikat masih berlakuTidak ada sosialisasi perpres54Hal 68

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>14<strong>03</strong> 16/06/2<strong>01</strong>1 S.176/BTNRAW-1/Um/2<strong>01</strong>11404 16/06/2<strong>01</strong>1 S.421/BTNKpS-1/2<strong>01</strong>1Kepala Balai Taman Nasional Rawa Aopa WatumohaiDitjend Perlindungan Hutan dan Konservasi AlamKemhutKepala Balai Taman Nasional Kepulauan SeribuDitjend Perlindungan Hutan dan Konservasi Alam,Kemhut10/10/11 14/10/11 16198935700<strong>03</strong>10/10/11 14/10/11 16198931600061405 16/06/2<strong>01</strong>1 050/SET/2<strong>01</strong>1 Kepala Bappeda Kab. Jayapura 10/10/11 17/10/11 16198931700051406 17/06/2<strong>01</strong>1 W24-A/614.a/PP.00.4/VI/2<strong>01</strong>1 Panitera/Sekretaris Pengadilan Tinggi Agama Ambon 10/10/11 17/10/11 16198931500071407 17/06/2<strong>01</strong>1 399/-089 Lurah Palmeriam Kec.matraman Pemprov. DKI Jakarta 10/10/11 17/10/11 16198929000091408 17/06/2<strong>01</strong>1 800/406/KepegSekretaris Dinas SDA, Pertambangan dan Energi,Pemkab Bandung10/10/11 17/10/11 6198932200071409 17/06/2<strong>01</strong>1 050/176/1.22/2<strong>01</strong>1 Sekretaris Kabupaten Pemkab Jember 17/10/11 28/10/11 16198921700061410 17/06/2<strong>01</strong>1 1438/PL16/LL/2<strong>01</strong>1 Direktur Politeknik Negeri Pontianak Kemdiknas Sertifikat masih berlaku1411 17/06/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>.3/644/2<strong>01</strong>1Kepala Biro Keuangan dan Barang Milik NegaraSetjend Kementerian Kesehatan17/10/11 31/10/11 1619892<strong>03</strong>00<strong>03</strong>1412 17/06/2<strong>01</strong>1 <strong>027</strong>/34.09.2/410.207.3/2<strong>01</strong>1 Sekretaris Daerah Pemkot Blitar 17/10/11 24/10/11 16198949500021413 17/06/2<strong>01</strong>1 <strong>027</strong>/1290/4<strong>03</strong>.021/2<strong>01</strong>1 Setda Pemkab Magetan 17/10/11 28/10/11 16198937100<strong>03</strong>1414 17/06/2<strong>01</strong>1 S.202/VI/BPPHP-XVIII/1/2<strong>01</strong>1Kepala Balai Pemantauan Pemanfaatan Hutan ProduksiWil. XVIII, Ditjend Bina Usaha KehutananKementerian Kehutanan10/10/11 13/10/11 16198925500061415 17/06/2<strong>01</strong>1 520.1/241/KKP/VI/2<strong>01</strong>1 Kepala Kantor Ketahanan Pangan Kab. Kotabaru 12/10/11 19/10/11 161989343000<strong>01</strong>416 17/06/2<strong>01</strong>1 <strong>027</strong>/670-II.1/BunSekretaris Dinas Perkebunan Pemprov. SumateraSelatan12/10/11 19/10/11 16198948100091417 17/06/2<strong>01</strong>1 B-1680/P.1.1/Cu.2/06/2<strong>01</strong>1 Wakil Kepala Kejaksaan Tinggi Bali 17/10/11 26/10/11 16198937000041418 20/06/2<strong>01</strong>1 B-449/S.2/Cr.1/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Maluku Utara Sertifikat masih berlaku1419 20/06/2<strong>01</strong>1 600/44/2<strong>01</strong>1 Sekretaris Daerah Pemkab Gayo Lues 12/10/11 19/10/11 161989350000<strong>01</strong>420 20/06/2<strong>01</strong>1 443.52/1159-Dinkes Kepala Dinas Kesehatan Kab. Ciamis <strong>03</strong>/11/11 14/11/11 16823563600081421 20/06/2<strong>01</strong>1 800/109/BPBD Kepala Pelaksana BPBD Kab. Bandung <strong>03</strong>/11/11 14/11/11 16823564400071422 20/06/2<strong>01</strong>1 3722/DPT.0/TU210S1/VI/2<strong>01</strong>1 Sesditjen. Perikanan Tangkap 17/10/11 26/10/11 16198922200081423 20/06/2<strong>01</strong>1 B/530/VI/2<strong>01</strong>1 Kepala Zidam III/Siliwangi 12/10/11 19/10/11 1619893670000Hal 69

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1424 20/06/2<strong>01</strong>1 B-288/O.6.2/Cu.2/06/2<strong>01</strong>1 Asisten Pembinaan Kejaksaan Tinggi Banten Sertifikat masih berlaku1425 20/06/2<strong>01</strong>1 UM.002/258/V/BO-2<strong>01</strong>11426 20/06/2<strong>01</strong>1 641.1/225/DCT-KH/2<strong>01</strong>11427 20/06/2<strong>01</strong>1 800/ BAPPEDA/VI/2<strong>01</strong>1Kepala Bandar Udara Serui Ditjend PerhubunganUdara KemhubKepala Dinas Cipta Karya dan Tata Ruang Kab.Kapuas HuluKepala BAPPEDA Pemkab Bolaang MongondowSelatan12/10/11 19/10/11 16198934400091428 20/06/2<strong>01</strong>1 B1367/P.2/Cp.2/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Nusa Tenggara Barat 12/10/11 19/10/11 16198934100021429 20/06/2<strong>01</strong>1 421/1561/429.1<strong>01</strong>/2<strong>01</strong>1Kabid. Pendidikan Dasar MEnengahDinas PendidikanPemuda dan Olahraga Pemkab Banyuwangi12/10/11 26/10/11 1619894<strong>03</strong>00<strong>01</strong>1430 20/06/2<strong>01</strong>1 800/1928/419.62/2<strong>01</strong>1 Kepala Badan Kepegawaian Daerah Pemkot Kediri 12/10/11 19/10/11 '16198934200<strong>01</strong>Sertifikat masih berlakuSertifikat sudah pernah dikonversi1431 20/06/2<strong>01</strong>1 - an. Iryansyah 11/11/11 25/11/11 16823580900021432 20/06/2<strong>01</strong>1 551.1/257/DISHUBKOMINFO/V/2<strong>01</strong> Kepala Dinas Perhubungan, Kominfo Pemkab Majene 12/10/11 19/10/11 161989349000411433 20/06/2<strong>01</strong>1 045.2/639/V/2<strong>01</strong>1 Kepala Dinas Kelautan dan Perikanan Pemkab Majene 12/10/11 19/10/11 16198935600041434 20/06/2<strong>01</strong>1 B-1205/Q.2.2/Cr.1/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Kalimantan Tengah1435 20/06/2<strong>01</strong>1 169/084Kapus Pelayanan Kesehatan Pegawai Prov. DKIJakarta12/10/11 19/10/11 16198934800051436 20/06/2<strong>01</strong>1 B-1670/0.4/Cp.2/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi DIY 17/10/11 24/10/11 1619894930004Sertifikat masih berlaku danTidak ada sosialisasi perpres541437 20/06/2<strong>01</strong>1 347/UN19.2/PL/2<strong>01</strong>1 Ketua Lemlit Universitas Riau 24/10/11 02‐11‐2<strong>01</strong>1 16198941700041438 20/06/2<strong>01</strong>1 B/1147/VI/2<strong>01</strong>1/SSDM Kabagrenmin Staf SDM Kepolisian Negara RI 24/10/11 28/10/11 16198941300081439 20/06/2<strong>01</strong>1 B/486/VI/2<strong>01</strong>1Dir. SDM dan Logistik Universitas PertahananIndonesia Kementerian Pertahanan12/10/11 19/10/11 16198935100091440 20/06/2<strong>01</strong>1 72/PPK1/6/2<strong>01</strong>1 PPK I <strong>LKPP</strong> 10/10/11 17/10/111441 21/06/2<strong>01</strong>1 B-106/C.2/Cr.1/06/2<strong>01</strong>1 Kepala Biro Perencanaan Kejaksaan Agung RI 27/10/11 11/11/11 16823561800021442 21/06/2<strong>01</strong>1 860/02/1/DISHUBKOMINFO1443 21/06/2<strong>01</strong>1 AU.108/716/VI/Plu-2<strong>01</strong>11444 21/06/2<strong>01</strong>1 420/7932/022/2<strong>01</strong>11445 21/06/2<strong>01</strong>1 600/55/Adm.Pemb.Kepala Dinas Perhubungan Komunikasi danInformatika Prov. Sumatera SelatanPelaksana Harian Kantor Bandar Udara MutiaraDitjend Perhubungan Udara Kementerian PerhubunganKepala Bagian Pengembangan Program SetdaPemprov. JatimAsisten Ekonomi Pembangunan Setda Pemkab LuwuUtara02/11/11 16/11/11 168235670000217/10/11 28/10/11 161989218000517/10/11 28/10/11 1619894080006Tidak melampirkan suratketerangan aktif dipengadaanHal 70

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1446 21/06/2<strong>01</strong>1 974/FTP-UGM/KP/2<strong>01</strong>1 Kepala Kantor Fakultas Teknologi Pertanian UGM 29/09/11 04/10/11 16198921800051447 21/06/2<strong>01</strong>1 050/1244/Ekbang Sekretaris Daerah Pemkab Sintang 24/10/11 28/10/11 16198941200091448 21/06/2<strong>01</strong>1 B-340/R.4.32/Cu.1/06/2<strong>01</strong>1 Kepala Sub.Bag. Pembinaan Kejaksaan Negeri Takalar Sertifikat masih berlaku1449 21/06/2<strong>01</strong>1 893.3/1057/Diklat-D Kepala Badiklat Prov. Kalimantan Barat 17/10/11 28/10/11 16198921600071450 21/06/2<strong>01</strong>1 SM.3<strong>01</strong>/1/<strong>01</strong>/DNG.SMG-11Kepala Distrik Navigasi Kelas II Semarang DitjendPerhubungan Laut Kem.Perhubungan17/10/11 20/10/11 16198948400061451 21/06/2<strong>01</strong>1 500/UM/564 Sekretaris Daerah Pemkab Bintan <strong>03</strong>/11/11 10/11/11 16823559200051452 21/06/2<strong>01</strong>1 SM.30/1/1/DNG.Jra-11 Kepala Kantor Distrik Navigasi Kelas II Jayapura 17/10/11 21/10/11 16198939500<strong>03</strong>1453 21/06/2<strong>01</strong>1 600/244/DPU/VI/2<strong>01</strong>1 Kepala Dinas PU Kab. Pulang Pisau 17/10/11 24/10/11 16198948900<strong>01</strong>1454 21/06/2<strong>01</strong>1 TU.<strong>01</strong>.02/09.IX.490/2<strong>01</strong>1 Kepala BTKL - PPM Kelas I Manado 17/10/11 20/10/11 16198938300081455 21/06/2<strong>01</strong>1 B-979/S1/Gum/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Maluku 17/10/11 20/10/11 16198948400061456 21/06/2<strong>01</strong>1 <strong>027</strong>/2552 Sekretaris Dinas Pertanian Pemprov DIY 17/10/11 20/10/11 16198928900<strong>03</strong>1457 22/06/2<strong>01</strong>1 893/1042Kepala Badan Kepegawaian Daerah PemkotYogyakarta24/10/11 04/11/11 16823550700071458 22/06/2<strong>01</strong>1 800/565/Kepeg Sekretaris Daerah Pemkot Tasikmalaya 17/10/11 31/10/11 16198920800081459 22/06/2<strong>01</strong>1 800/1376/BKD Kepala BKD Kota Denpasar 17/10/11 20/10/11 16198933000061460 22/06/2<strong>01</strong>1 600/183/2<strong>01</strong>1Kepala Dinas Kelautan dan Perikanan PemkabJayapura1461 22/06/2<strong>01</strong>1 0<strong>01</strong>97/PL/06/2<strong>01</strong>1/ULP Kepala ULP Kementerian Luar Negeri1462 22/06/2<strong>01</strong>1 B/567/VI/2<strong>01</strong>1 Dirbinlem Sekolah Staf dan Komando Mabes AD17/10/11 21/10/11 16198938400071463 22/06/2<strong>01</strong>1 893.3/368/BPM/2<strong>01</strong>1Kaban Pemberdayaan Masyarakat Kab. MandailingNatalKepala Balai Taman Nasional Sembilang Ditjend17/10/11 19/10/11 16198936200051464 22/06/2<strong>01</strong>1 S.304/IV-T.7/2<strong>01</strong>1Perlindungan Hutan dan Konservasi Alam17/10/11 19/10/11 1619893630004Kem Kehutanan1465 22/06/2<strong>01</strong>1 B-1329/N.7/Cum.1/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Bengkulu 17/10/11 19/10/11 1619893680009Sama dengan <strong>No</strong>. Surat0<strong>01</strong>21/PL/04/2<strong>01</strong>1/ULPTidak ada sosialisasi perpres541466 22/06/2<strong>01</strong>1 050/100/431.005.1/2<strong>01</strong>1 Kepala Bagian Pembangunan Setda Pemkab Situbondo 17/10/11 21/10/11 16198938900021467 22/06/2<strong>01</strong>1 B-907/R.3/Cpl.1/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Sulawesi Tenggara 17/10/11 20/10/11 16198948300071468 22/06/2<strong>01</strong>1 246/PEN.1/6/2<strong>01</strong>1 Sekretaris Ditjen Pengembangan Ekspor Nasional 17/10/11 21/10/11 16198938800<strong>03</strong>Hal 71

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1469 22/06/2<strong>01</strong>1 TU.02.02/IX.3/<strong>01</strong>/2<strong>01</strong>1Kepala Balai Besar Teknik Kesehatan Lingkungan danPemberantasan Penyakit Menular Yogyakarta DitjendPengendalian Penyakit dan Penyehatan LingkunganKementerian Kesehatan17/10/11 21/10/11 16198938200091470 22/06/2<strong>01</strong>1 470/33.084.22 Kepala Puskesmas Kecamatan Kebayoran Lama 17/10/11 21/10/11 161989497000<strong>01</strong>471 22/06/2<strong>01</strong>1 B-580/Q.4/Cu/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Kalimantan Timur 17/10/11 24/10/11 16198946300<strong>03</strong>1472 22/06/2<strong>01</strong>1 234/SJ-IND.6.1/06/2<strong>01</strong>1Pembantu Ketua II STT Tekstil KementerianPerindustrian17/10/11 24/10/11 16198949400<strong>03</strong>1473 22/06/2<strong>01</strong>1 <strong>027</strong>/460 Sekretaris Daerah Pemkab Pekalongan 17/10/11 24/10/11 16198946700091474 22/06/2<strong>01</strong>1 020/134/Pemb/VI-2<strong>01</strong>1 Sekretaris Daerah Kota Bukittinggi 17/10/11 24/10/11 16198949200051475 23/06/2<strong>01</strong>1 UK.104/16/10/Upp.Bwn-2<strong>01</strong>1Kepala Kantor Unit Penyelenggara Pelabuhan BaweanDitjen Perhubungan Laut Kementerian Perhubungan17/10/11 20/10/11 16198948200081476 23/06/2<strong>01</strong>1 800/2238/I.06/2<strong>01</strong>1 Sekretaris Daerah Pemkab Lampung Selatan 17/10/11 26/10/11 16198948700<strong>03</strong>1477 23/06/2<strong>01</strong>1 800/635/NT-SET.2Kepala Dinas Tenaga Kerja dan Transmigrasi Prov.Kalbar17/10/11 21/10/11 16198950000<strong>03</strong>1478 23/06/2<strong>01</strong>1 B 622/P2KTrans-SES/VI/2<strong>01</strong>1Sekretaris Ditjend Pembinaan Pembangunan KawasanTransmigrasi<strong>03</strong>/11/11 06‐12‐2<strong>01</strong>1 16823613700091479 23/06/2<strong>01</strong>1 B/405-09/20/04/Depohar 20Komandan Depo Pemeliharaan 20 KomandoPemeliharaan Materiil TNI AU17/10/11 26/10/11 16198937300<strong>01</strong>1480 23/06/2<strong>01</strong>1 - Setda Pemkab Sumbawa Barat 17/10/11 24/10/11 16198949800091481 23/06/2<strong>01</strong>1 800/1786/Peg/VI/2<strong>01</strong>1 Plt. Kepala Dinas Kesehatan Kab. Nias Selatan 17/10/11 24/10/11 16198948800021482 23/06/2<strong>01</strong>1 S.693/VIII/Set-4/2<strong>01</strong>1Sekretaris Badan Litbang Kehutanan KementerianKehutanan17/10/11 06‐12‐2<strong>01</strong>1 168236136000<strong>01</strong>483 23/06/2<strong>01</strong>1 B/5156/VI/2<strong>01</strong>1/Rosarpras Karo Sarpras Kepolisian Negara Daerah Bali 24/10/11 31/10/11 16198947400091484 23/06/2<strong>01</strong>1 UM.<strong>01</strong>.11/Au/364Kepala Balai Besar Wilayah Sungai PompenganJeneberang Ditjend SDA Kementerian PU<strong>03</strong>/11/11 18/11/11 16823568400051485 23/06/2<strong>01</strong>1 <strong>027</strong>/1831/Adpem Sekretaris Daerah Pemkab Sumedang 21/10/11 31/10/11 16198920400021486 23/06/2<strong>01</strong>1 B/2504/VI/2<strong>01</strong>1/ Ro Sarpras Waka Kepolisian Daerah Kalimantan Timur Sertifikat Masih Berlaku1487 23/06/2<strong>01</strong>1 028/1509/Dalprog Sekretaris Daerah Kota Cilegon 24/10/11 04/11/11 16823551500061488 23/06/2<strong>01</strong>1 870/106/BAPPEDA/2<strong>01</strong>1 Kepala Bappeda Kab. Puncak Jaya 17/10/11 20/10/11 16198933900071489 23/06/2<strong>01</strong>1 b-818/r.5/Cu.2/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Gorontalo Sertifikat Masih Berlaku1490 24/06/2<strong>01</strong>1 B/1386/V/2<strong>01</strong>1/BNN Sekretaris Utama Badan Narkotika Nasional (BNN) 11/10/11 19/10/11 1619893650002Sama dengan <strong>No</strong>. SuratB/141/VI/2<strong>01</strong>1/BNNHal 72

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1491 24/06/2<strong>01</strong>1 327/KP.400.L.14.B/06/11Kepala Balai Karantina Pertanian Kelas I BandarLampung Badan Karantina Pertanian KementerianPertanian17/10/11 20/10/11 161989381000<strong>01</strong>492 24/06/2<strong>01</strong>1 <strong>027</strong>/16/Bang/2<strong>01</strong>1 Asisten Pertahanan dan Kesra Setda Pemkab Landak 17/10/11 20/10/11 16198934000<strong>03</strong>1493 24/06/2<strong>01</strong>1 620/SEKRT.295/DBMP/VI/2<strong>01</strong>11494 24/06/2<strong>01</strong>1 530/PERINDAG/VI/2<strong>01</strong>1/1981495 24/06/2<strong>01</strong>1 S.372/TN.TBR-1/2<strong>01</strong>1Kepala Dinas Bina Marga dan Pengairan PemkotSamarindaKepala Dinas Perindustrian dan Perdagangan PemkabBengkalisKepala Balai Taman Nasional Taka Bonerate DitjendPerlindungan Hutan dan Konservasi Alam KementerianKehutanan21/10/11 02‐11‐2<strong>01</strong>1 16198919900<strong>01</strong>17/10/11 20/10/11 1619894860004Tidak ada SosialisasiPerpres 541496 24/06/2<strong>01</strong>1 933/A.Pemb-NGK/93/06/2<strong>01</strong>1 Bupati Nagekeo 24/10/11 31/10/11 16198946800081497 24/06/2<strong>01</strong>1 B-1757/O.5/Cpl/06/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Jawa Timur Persyaratan tidak lengkap1498 27/06/2<strong>01</strong>1 602.2/364/DBC/2<strong>01</strong>1 Kepala Dinas Bina Marga dan Cipta Karya Aceh 17/10/11 26/10/11 16198940500091499 27/06/2<strong>01</strong>1 522.3/PPHH/2<strong>01</strong>1/530.06 Kepala Dinas Kehutanan Kab. Rokan Hilir 17/10/11 24/10/11 16198949900081500 27/06/2<strong>01</strong>1 800/143/V/BPMD/2<strong>01</strong>1Plt. Kepala Badan Pemberdayaan Masyarakat dan DesaKab. Kotawaringin Timur17/10/11 24/10/11 16198946500<strong>01</strong>15<strong>01</strong> 27/06/2<strong>01</strong>1 042/<strong>027</strong>/182/Kesbang/VI/2<strong>01</strong>0Kepala Badan Kesbang, Politik dan Linmas Kab.Kotawaringin Timur17/10/11 24/10/11 16198946200041502 27/06/2<strong>01</strong>1 045.2/499/VI/PHB-2<strong>01</strong>1 Kepala Dinas Perhubungan Kominfo Prov. Sultra 17/10/11 24/10/11 161989464000215<strong>03</strong> 27/06/2<strong>01</strong>1 <strong>027</strong>/0778/Bina Program/2<strong>01</strong>1 Sekretrais Daerah Pemkab Karo 20/10/11 02‐11‐2<strong>01</strong>1 16823553400<strong>01</strong>1504 27/06/2<strong>01</strong>1 <strong>027</strong>/3430/DPU/2<strong>01</strong>1 Sekretaris Daerah Pemprov. Bengkulu 24/10/11 31/10/11 16198920500<strong>01</strong>1505 27/06/2<strong>01</strong>1 B/2212/VI/2<strong>01</strong>1/Pusdokkes Kapusdokkes Mabes Polri 11/11/11 25/11/11 16823581500<strong>03</strong>1506 27/06/2<strong>01</strong>1 890/598/DIKLAT/2<strong>01</strong>1;890/599/DIKLAT/2<strong>01</strong>1Kepala Badiklat Prov. Papua Barat1507 27/06/2<strong>01</strong>1 W.19-A/918/PL.<strong>01</strong>/VI/2<strong>01</strong>1 Ketua Pengadilan Tinggi Agama Palu 20/10/11 31/10/11 16198947200<strong>01</strong>1508 27/06/2<strong>01</strong>1 63513.494Kepala Badan Pusat Statistik (BPS) Prov. KalimantanSelatan1509 27/06/2<strong>01</strong>1 800/376/RSUD/2<strong>01</strong>1 Dir. RSUD Kab. Sanggau 20/10/11 31/10/11 1619892090007Sertifikat masih berlakuTidak ada sosialisasi perpres541510 27/06/2<strong>01</strong>1 1065/Dishut-I/U4/2<strong>01</strong>1 Kepala Dinas Kehutanan Pemprov. Kalimantan Barat 20/10/11 31/10/11 16198920700091511 28/06/2<strong>01</strong>1 819/-0721512 28/06/2<strong>01</strong>1 900/246-A-KD/DPPKADStaf Sub. Bag Tata Usaha Suku Dinas Sosial PemkotAdministrasi Jakarta TimurKepala Dinas Pendapatan, Pengelolaan Keuangan danAset Daerah Pemkot Banjarmasin20/10/11 28/10/11 1619893940004Tidak ada sosialisasi perpres54Hal 73

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1513 28/06/2<strong>01</strong>1 B/1515/VI/2<strong>01</strong>1 Asisten Logistik Mabes AD 24/10/11 31/10/11 16198947500081514 28/06/2<strong>01</strong>1 600/Pemb/481 Sekretaris Daerah Pemkab Bintan <strong>03</strong>/11/11 21/11/11 16823576300<strong>01</strong>1515 28/06/2<strong>01</strong>1 B/4454/VI/2<strong>01</strong>1/BARANAHANSekretaris Badan Sarana Pertahanan KementerianPertahanan1516 28/06/2<strong>01</strong>1 800/655-Umpeg/Dishut Kepala Dinas Kehutanan Pemprov. Kalimantan Selatan20/10/11 31/10/11 16198947100021517 28/06/2<strong>01</strong>1 B/811-09/20/<strong>03</strong>/Slogau Asisten Logistik Mabes AU 07/11/11 25/11/11 1682358380004Tidak ada fotocopysertifikat1518 28/06/2<strong>01</strong>1 800/202/B.I/DKP/2<strong>01</strong>1 Kepala Dinas Kelautan dan Perikanan Pemkab Kaur 20/10/11 31/10/11 16198947600071519 28/06/2<strong>01</strong>1 900/374/DPPKAD/2<strong>01</strong>1Kepala Dinas Pendapatan, Pengelolaan Keuangan danAset Daerah Pemkab Kaur20/10/11 31/10/11 16198945600<strong>03</strong>1520 28/06/2<strong>01</strong>1 800/256/DishubkominfoKepala Dinas Perhubungan Komunikasi danInformatika Kab. Bungo20/10/11 31/10/11 161989473000<strong>01</strong>521 28/06/2<strong>01</strong>1 910/072/122Asisten Ekonomi Pembangunan dan Kesra Setda KotaMagelang24/10/11 28/10/11 1619894500009Sekretaris BPSDMKP Kementerian Kelautan dan1522 28/06/2<strong>01</strong>1 B.504/BPSDMKP.<strong>01</strong>/TU.210/VI/2<strong>01</strong>1Perikanan20/10/11 10/11/11 16823559800091523 28/06/2<strong>01</strong>1 540/tamben.BMU/149/2<strong>01</strong>1Kepala Dinas Pertambangan dan Energi Kab. BolaangMongondow Utara19/10/11 28/10/11 16198945200071524 28/06/2<strong>01</strong>1 600/DPU/123/VI/2<strong>01</strong>1Kepala Dinas Pekerjaan Umum Kab. BolaangMongondow Utara19/10/11 28/10/11 16198921900041525 28/06/2<strong>01</strong>1 29/SP/BP/VI/2<strong>01</strong>1 Kabag Bina Program Setda Pemkot Batam 27/10/11 16/11/11 16823566700081526 28/06/2<strong>01</strong>1 TU.05.02/II.1/6024/2<strong>01</strong>1Dirut RSUP dr. Soeradji Tirtonegoro Ditjen BinaUpaya Kesehatan Kemkes19/10/11 28/10/11 16198922100091527 28/06/2<strong>01</strong>1 0824/UMU-VI/CSQA/2<strong>01</strong>1 VP. Divisi Umum PT. Sucofindo 19/10/11 26/10/11 16198936900081528 28/06/2<strong>01</strong>1 B/258-09/19/<strong>01</strong>/Depo 60Kemandan Depo Pemeliharaan 60 KomandoPemeliharaan Materiil TNI AU19/10/11 02‐11‐2<strong>01</strong>1 16198919800021529 28/06/2<strong>01</strong>1 110/UN33.9/PM/2<strong>01</strong>1 Sekretaris LPM Universitas Negeri Medan 27/10/11 21/11/11 16823570000021530 28/06/2<strong>01</strong>1 21/Kpts/KPU-MU//2<strong>01</strong>1 Komisi Pemilihan Umum Kab. Minahasa Utara 02/11/111531 28/06/2<strong>01</strong>1 SDM-UM/X/18 s/d 21/VI/2<strong>01</strong>1Kepala Bagian SDM-Umum PT. Perkebunan MitraOgan02/11/111532 28/06/2<strong>01</strong>1 <strong>027</strong>/1259/SETWAN/2<strong>01</strong>1Kepala Bagian Umum Sekretariat DPRD PemkabBanyuasin02/11/111533 28/06/2<strong>01</strong>1 058/199/DISNAKER/VI/2<strong>01</strong>1 Kepala Dinas Tenaga Kerja Pemkot LubukLinggau 02/11/11Tidak ada alamatpengiriman sertifikat1534 28/06/2<strong>01</strong>1 610/143/DPUP/2<strong>01</strong>1 Kepala Dinas PU Pengairan Kab. Musi Rawas 02/11/111535 28/06/2<strong>01</strong>1 523.187/V/2<strong>01</strong>1Plt. Kepala Dinas Kelautan dan Perikanan Kab. SeramBagian Timur10/10/11tidak ada alamat pengirimanHal 74

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1536 28/06/2<strong>01</strong>1 789/86/2<strong>01</strong>1Kepala Badan Pemberdayaan Masyarakat PemerintahDesa dan KB10/10/11sertifikat1537 30/06/2<strong>01</strong>1 839/BP3TI.1/Kominfo/6/2<strong>01</strong>1Lakhar Kepala Balai Penyedia dan PengelolaPembiayaan Telekomunikasi dan Informatika DitjenPenyelenggaraan Pos dan Informatika Kem. KominfoPersyaratan tidak lengkap1538 30/06/2<strong>01</strong>1 SEK.4.PL.02.<strong>03</strong>-3381539 30/06/2<strong>01</strong>1 HM.<strong>03</strong>.<strong>01</strong>.94.06.11.2808Kepala Biro Perlengkapan Setjend KementerianHukum dan HAMKepala Balai Besar Pengawas Obat dan Makanan diBandung1540 30/06/2<strong>01</strong>1 005/2167/Dikes Kepala Dinas Kesehatan Kota Denpasar 27/10/11 04/11/11 1682355120009Persyaratan tidak lengkapTidak ada fotocopysertifikat1541 30/06/2<strong>01</strong>1 982/TU.210/I.6/06/2<strong>01</strong>1Kepala Bagian Tata Usaha Balai Besar Penelitian danPengembangan Sumberdaya Lahan Pertanian,Balitbang Pertanian, Kementerian PertanianTidak ada surat keteranganhilang dari kepolisian1542 30/06/2<strong>01</strong>1 593/SJ.3/KOMINFO/6/2<strong>01</strong>1 Kepala Biro Keuangan Setjend Kementerian Kominfo Persyaratan tidak lengkap1543 30/06/2<strong>01</strong>1 640/54/ADM.PEMB/VI/2<strong>01</strong>1 Sekretaris Daerah Kab. Luwu 24/10/11 28/10/11 16198945100081544 30/06/2<strong>01</strong>1 - an. Yunas Tantan1545 30/06/2<strong>01</strong>1 157/Sesprov-<strong>01</strong>9/VI/2<strong>01</strong>11546 30/06/2<strong>01</strong>1 893.5/507/BPKD/Set.2Kabag Keuangan, Umum dan Logistik KPU Prov.Kalimantan BaratKepala Badan Perpustakaan, Kearsipan danDokumentasi Prov. Kalimantan Barat02/11/11 11/11/11 16823561500051547 30/06/2<strong>01</strong>1 S-426/AG.1/2<strong>01</strong>1 Sekretaris Ditjend Anggaran Kementerian Keuangan 21/10/11 02‐11‐2<strong>01</strong>1 1682355350000Tidak ada sosialisasiPerpres 54Sertifikat masih berlaku1548 30/06/2<strong>01</strong>1 <strong>027</strong>/LPKN/VI/2<strong>01</strong>1 Ketua Umum LPKN Sertifikat masih berlaku1549 30/06/2<strong>01</strong>1 1522/PL16/LL/2<strong>01</strong>1 Direktur Politeknik Negeri Pontianak Kemdiknas 21/10/11 02‐11‐2<strong>01</strong>1 16198920000061550 30/06/2<strong>01</strong>1 S.352/UM-4/2<strong>01</strong>1 Kepala Biro Umum Setjend Kementerian Kehutanan 21/10/11 04/11/11 16823552400041551 30/06/2<strong>01</strong>1 S.458/BPDAS.WSS-1/2<strong>01</strong>1Kepala Balai Pengelolaan Daerah Aliran Sungai WaySeputih Way Sekampung Ditjend Bina PengelolaanDAS dan Perhutanan Sosial Kementerian Kehutanan21/10/11 02‐11‐2<strong>01</strong>1 161989206000<strong>01</strong>552 30/06/2<strong>01</strong>1 2<strong>01</strong>2/KT.0<strong>03</strong>/H.1/VI-2<strong>01</strong>1 Plh. Sekretaris BKKBN 02/11/11 21/11/11 1682357<strong>03</strong>00091553 30/06/2<strong>01</strong>1 600-189/Set-Bang.IIKepala Bagian Administrasi Pembangunan SetkabKutai Kartanegara20/10/11 02‐11‐2<strong>01</strong>1 16198941500061554 30/06/2<strong>01</strong>1 816/714/DISHUBKOMINFOKepala Dinas Perhubungan Komunikasi danInformatika Prov. Sulawesi Tengah20/10/11 31/10/11 16198945700021555 30/06/2<strong>01</strong>1 <strong>027</strong>/2239 Sekretaris Daerah Kabupaten Buton 20/10/11 28/10/11 1619892140009Hal 75

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>Dir. Keuangan dan Administrasi Umum RSJ Dr.1556 30/06/2<strong>01</strong>1 DM<strong>03</strong>.<strong>01</strong>/II/3048/2<strong>01</strong>1Soeharto Heerdjan, Ditjend Pelayanan Medik Kem. 20/10/11 28/10/11 161989213000<strong>01</strong>557 30/06/2<strong>01</strong>1 047/527/II/BKPMD/2<strong>01</strong>1KesehatanSekretaris Badan Koordinasi Penanaman Modal Daerah(BKPMD) Pemprov. Sulawesi Selatan20/10/11 31/10/11 16198921000<strong>03</strong>1558 30/06/2<strong>01</strong>1 0227/1580/V/2<strong>01</strong>1 Sekretaris Daerah Pemprov. Sumatera Selatan <strong>03</strong>/10/11 04/10/11 16198880000<strong>03</strong>1559 30/06/2<strong>01</strong>1 893/Pemb/548/VI/2<strong>01</strong>1 Sekretaris Daerah Kota Bitung 20/10/11 04/11/11 16823551300081560 30/06/2<strong>01</strong>1 045.2/51Asisten Ekonomi dan Pembangunan Setda KotaSabang<strong>01</strong>/11/11 23/11/11 16823577400071561 30/06/2<strong>01</strong>1 B/356-09/32/<strong>01</strong>/Korpaskhas Komandan Korps Pasukan Khas TNI AU 02/11/111562 30/06/2<strong>01</strong>1 SM.307/1/3/DJPL-11Kepala Bagian Kepegawaian dan Hukum DitjendPerhubungan Laut Kementerian Perhubungan02/11/11 11/11/11 16823560900041563 30/06/2<strong>01</strong>1 W15.E10.PL.02.<strong>03</strong>-214Kepala Lembaga Pemasyarakatan Klas IIB TakalarKanwil Sulsel Kemhukham<strong>03</strong>/11/11 11/11/11 16823562300041564 30/06/2<strong>01</strong>1 <strong>027</strong>/1189/Umum.DSKCS/2<strong>01</strong>1Kepala Dinas Sosial, Kependudukan dan Catatan SipilPemkab Bandung24/10/11 28/10/11 16198939300051565 30/06/2<strong>01</strong>1 B/327-09/20/06/Koharmatau Komandan Koharmatau TNI AU <strong>01</strong>/11/11 09/11/11 16823559100061566 30/06/2<strong>01</strong>1 -Direktur Pendidikan Agama Islam pada Sekolah, DitjenPendidikan Islam Kementerian Agama<strong>03</strong>/11/11 14/11/11 16823564000<strong>01</strong>1567 30/06/2<strong>01</strong>1 -Plt. Kepala Dinas Pekerjaan Umum Pemkab LampungTimur<strong>01</strong>/11/11 09/11/11 16823558900<strong>01</strong>1568 <strong>01</strong>/07/2<strong>01</strong>1 TU.05.02/I/1.2/1352/2<strong>01</strong>1 Direktur Politeknik Kesehatan Kemenkes Manado <strong>03</strong>/11/11 14/11/11 1682356390005Tidak ada alamatpengiriman sertifikat1569 <strong>01</strong>/07/2<strong>01</strong>1 050/1306/Dinsos Sekretaris Dinas Sosial Pemprov. Bali <strong>03</strong>/11/11 15/11/11 16823564900021570 <strong>01</strong>/07/2<strong>01</strong>1 020/3220/BPM/VI/2<strong>01</strong>1 Kepala Badan Pemberdayaan Masyarakat Aceh <strong>03</strong>/11/11 28/11/11 16823587400061571 <strong>01</strong>/07/2<strong>01</strong>1 227/PDAM-LE/ME/VI/2<strong>01</strong>1 Dirut PDAM Lematang Enim Kab. Muara Enim Persyaratan tidak lengkap1572 <strong>01</strong>/07/2<strong>01</strong>1 893/5907/I-1 Kepala Dinas Kesehatan Prov. DIY <strong>03</strong>/11/11 14/11/11 16823563200021573 <strong>01</strong>/07/2<strong>01</strong>1 893.3/1145/Diklat-DKabid Teknis dan Fungsional Badiklat Pemprov.Kalimantan Barat<strong>03</strong>/11/11 15/11/11 16823564700041574 <strong>01</strong>/07/2<strong>01</strong>1 583/SJ.3/KOMINFO/6/2<strong>01</strong>1 Kepala Biro Keuangan Setjend Kementerian Kominfo 31/10/11 09/11/11 16823558500051575 04/07/2<strong>01</strong>1 700/89/BUP/2<strong>01</strong>1 Bupati Yalimo 02/11/11 25/11/11 16823580500061576 04/07/2<strong>01</strong>1 199/BU/VII/2<strong>01</strong>11577 04/07/2<strong>01</strong>1 S-233/KPU.02/PSO/2<strong>01</strong>1Kepala Biro Umum Sekretariat Kementerian Riset danTeknologiPlh. Kepala Pangkalan Sarana Operasi Bea dan CukaiTipe B Batam Kantor Pelayanan Utama Tipe B BatamDitjen Bea dan Cukai Kementerian Keuangan14/11/11 02‐12‐2<strong>01</strong>1 1682359930000<strong>01</strong>/11/11 10/11/11 1682356280009Hal 76

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1578 04/07/2<strong>01</strong>1 B-549/N.10.1/Cu.3/06/2<strong>01</strong>1 Wakil Kepala Kejaksaan Tinggi Kepulauan Riau1579 04/07/2<strong>01</strong>1 PL.00.<strong>01</strong>/II/1717/2<strong>01</strong>1 Direktur Politeknik Kemenkes Jakarta II <strong>01</strong>/11/11 10/11/11 1682356<strong>03</strong>0000Tidak ada fotocopysertifikat1580 04/07/2<strong>01</strong>1 028/1510/Dalprog Sekretaris Daerah Kota Cilegon Sudah pernah dikonversi1581 04/07/2<strong>01</strong>1 900/483.a/35.09.611/2<strong>01</strong>1 Direktur RSD Balung <strong>01</strong>/11/11 09‐11‐2<strong>01</strong>1 16823558300071582 04/07/2<strong>01</strong>1 800/1<strong>01</strong>4/423.102.64/2<strong>01</strong>1 Kepala UPT SMK Negeri 2 Pasuruan <strong>03</strong>/11/11 10/11/11 1682356<strong>01</strong>00021583 04/07/2<strong>01</strong>1 <strong>027</strong>/K166-EkbangTP/VI/2<strong>01</strong>1 Plt. Sekretaris Daerah Pemkot Bekasi <strong>01</strong>/11/11 11/11/11 168235610000<strong>01</strong>584 04/07/2<strong>01</strong>1 2451/P2.1/LK/2<strong>01</strong>1Plt. Kepala Pusat Informasi dan Hubungan MasyarakatKemdiknas02/11/11 11/11/11 16823561300071585 04/07/2<strong>01</strong>1 800/0477.1/III.18/06/2<strong>01</strong>1 Kepala Dinas Pendapatan Provinsi Lampung <strong>01</strong>/11/11 04/11/11 16823551800<strong>03</strong>1586 04/07/2<strong>01</strong>1 UM.002/B.368/VI/PPSDML-2<strong>01</strong>1 Kepala Pusat Pengembangan SDM Perhubungan Laut <strong>01</strong>/11/11 04/11/11 16823551400071587 04/07/2<strong>01</strong>1 810/380/BDC/2<strong>01</strong>1 Kepala Dinas Bina Marga dan Cipta Karya Aceh <strong>01</strong>/11/11 11/11/11 16823560700061588 05/07/2<strong>01</strong>1 0<strong>01</strong>/LKI-Konversi/VI/2<strong>01</strong>1 Ketua Lembaga Kajian Indonesia <strong>01</strong>/11/11 11/11/11 16823561100091589 05/07/2<strong>01</strong>1 893.3/4613/Pemb/2<strong>01</strong>1 Sekretaris Daerah Pemkab Nias Selatan <strong>01</strong>/11/11 10/11/11 16823559400<strong>03</strong>1590 05/07/2<strong>01</strong>1 W1-TUN4/266A/KS.00/VI/2<strong>01</strong>1 Ketua Pengadilan Tata Usaha Negara Bandar Lampung <strong>01</strong>/11/11 04/11/11 16823551700041591 05/07/2<strong>01</strong>1 4802/SAFVER-PMO/S/VII/2<strong>01</strong>1Direktur SAFVER Ditjend Perikanan BudidayaKementerian KP1592 05/07/2<strong>01</strong>1 800/1283-Bappeda Kepala Bappeda Kab. Bekasi 24/10/11 28/10/11 1619894060008Tidak ada sosialisasiPerpres 54Sekretaris Ditjend Perhubungan Darat Kementerian1593 05/07/2<strong>01</strong>1 SM.3<strong>01</strong>/1/7/DJPD/2<strong>01</strong>114/10/11 18/10/11 16198935900<strong>01</strong>Perhubungan1594 05/07/2<strong>01</strong>1 - an Hadi <strong>No</strong>vian & <strong>No</strong>rsetiawan Sertifikat masih berlaku1595 05/07/2<strong>01</strong>1 U.440/II.1/TVRI/2<strong>01</strong>1 Kepala TVRI Stasiun Jawa Timur1596 05/07/2<strong>01</strong>1 <strong>027</strong>/1427/132Asisten Humas, Perlengkapan dan Umum SetdaPemkot Magelang24/10/11 28/10/11 16198921200<strong>01</strong>1597 06/07/2<strong>01</strong>1 050/0404/Adbang/2<strong>01</strong>1Kabag. Administrasi Pembangunan Setda Kab.Wonosobo24/10/11 28/10/11 16198940900051598 06/07/2<strong>01</strong>1 050/0469/Adpemb Asisten Pemerintahan Setda Pemkab Sarolangun <strong>01</strong>/11/11 15/11/11 1682356520006Tidak ada sosialisasi perpres541599 06/07/2<strong>01</strong>1 912/Pemb-Um/342/2<strong>01</strong>1 Sekretaris Daerah Pemkab Rokan Hulu <strong>01</strong>/11/11 15/11/11 16823565100071600 06/07/2<strong>01</strong>1 DP.02/5653/SETJEN/VII/2<strong>01</strong>1Kepala Biro Keanggotaan dan Kepegawaian SetjendDPR-RI27/10/11 09/11/11 1682355900007Hal 77

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>16<strong>01</strong> 06/07/2<strong>01</strong>1 B/573/VI/2<strong>01</strong>1 Kepala Disbintalad Mabes AD 02/11/11 14/11/11 16823564200091602 06/07/2<strong>01</strong>1 6<strong>01</strong>/1141/VI/Program Sekretaris Daerah Pemkab Bone Persyaratan tidak lengkap16<strong>03</strong> 06/07/2<strong>01</strong>1 <strong>027</strong>/24<strong>01</strong> Setda Kota Sabang1604 06/07/2<strong>01</strong>1 S-7572/WPJ.12/KP.09/2<strong>01</strong>1Kepala KPP Madya Malang Kanwil Jatim II DitjenPajak Kementerian Keuangan1605 06/07/2<strong>01</strong>1 800/372/35.73.306/2<strong>01</strong>1 Kepala Dinas Kesehatan Pemkot MAlang<strong>01</strong>/11/11 09/11/11 16823558700<strong>03</strong>1606 06/07/2<strong>01</strong>1 - an Benyamin Bukit 26/07/11 28/07/11 1619882590005Sudah pernah diajukankonversiSudah pernah diajukankonversi1607 07/07/2<strong>01</strong>1 656/-073.55 Camat Cakung <strong>01</strong>/11/11 09/11/11 16823557900041608 07/07/2<strong>01</strong>1 246/Setda.Ekbang Plt. Sekretaris Daerah Pemkab Kepulauan Anambas 14/10/11 18/10/11 '16198935200081609 07/07/2<strong>01</strong>1 065/131/Adm.Pemb/2<strong>01</strong>1 Wakil Bupati Pasaman Barat 19/09/11 23/09/11 16198878500051610 07/07/2<strong>01</strong>1 - an. Deny Ismanto <strong>01</strong>/11/11 10/11/11 16823560200<strong>01</strong>1611 07/07/2<strong>01</strong>1 600/71/DPU-WRP/VI/2<strong>01</strong>1 Sekretaris Dinas PU Pemkab Waropen Sertifikat masih berlaku1612 07/07/2<strong>01</strong>1 061/1145/11k Kepala Dinas Kelautan dan Perikanan Prov. Maluku <strong>01</strong>/11/11 10/11/11 16823559600<strong>01</strong>1613 07/07/2<strong>01</strong>1 750/PL.200/A.3/VII/2<strong>01</strong>1Kepala Biro Hukum dan Informasi Publik KementerianPertanian1614 07/07/2<strong>01</strong>1 050/186/VI/2<strong>01</strong>1 Asisten Administrasi Umum Setda Pemkab Sukoharjo 02/11/11 06‐12‐2<strong>01</strong>1 16823613800081615 07/07/2<strong>01</strong>1 800/452/2/2<strong>01</strong>1Wakil Badan Pengendalian Dampak LingkunganPemerintah Aceh02/11/11 16/11/11 16823566300021616 07/07/2<strong>01</strong>1 893.3/245 Sekretaris Kecamatan Semanu Pemkab Gunungkidul 02/11/11 16/11/11 168235665000<strong>01</strong>617 07/07/2<strong>01</strong>1 HM.<strong>03</strong>.<strong>01</strong>.94.07.11.28551618 07/07/2<strong>01</strong>1 85/-1.821619 07/07/2<strong>01</strong>1 B/866/VII/2<strong>01</strong>1Kepala Balai Besar Pengawas Obat dan Makanan diBAndungKepala Suku Dinas Kebudayaan Kota AdministrasiJakarta BaratSekretaris Pusat Kesenjataan Artileri Medan KodiklatTNI AD11/08/11 06/10/11 1619889600004Sertifikat masih berlakuTidak ada fotocopysertifikat<strong>03</strong>/04/12 02<strong>01</strong>29004727 Sertifikat masih berlaku1620 07/07/2<strong>01</strong>1 050/2867 Asisten Administarsi Setda Pemkab Tegal Sudah pernah dikonversi1621 07/07/2<strong>01</strong>1 - an. Trisnan Saputra 02/11/11 16/11/11 16823566600091622 07/07/2<strong>01</strong>1 PHN.1-PH.02.02-980Sekretaris Badan Pembinaan Hukum NasionalKementerian Hukum dan HAM1623 11/07/2<strong>01</strong>1 916/415/Ekbang Plt. Sekretaris Daerah Pemkab Tojo Una-una 02/11/11 21/11/11 1682357<strong>01</strong>00<strong>01</strong>Tidak ada sosialisasi perpres54Hal 78

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1624 11/07/2<strong>01</strong>1 PD.<strong>03</strong>02-Cs.6/237.1Kepala Balai Teknik Air Minum dan Sanitasi WilayahII Kementerian PU1625 11/07/2<strong>01</strong>1 000/PDAM.GR/124 Dirut PDAM Pemkab Gianyar 02/11/11 16/11/11 16823566100041626 11/07/2<strong>01</strong>1 PL.04.<strong>01</strong>.3/760/2<strong>01</strong>1Kepala Biro Keuangan dan Barang Milik NegaraSetjend Kementerian KesehatanTidak ada fotocopysertifikatSudah pernah dikonversi1627 11/07/2<strong>01</strong>1 570/445/RSUD Poso/2<strong>01</strong>1 Dir. RSUD Poso Sertifkat masih berlaku1628 11/07/2<strong>01</strong>1 - an. Achmad Setiyo Prabowo 02/11/11 16/11/11 16823565700<strong>01</strong>1629 11/07/2<strong>01</strong>1 B/343-09/20/06/Koharmatau Komandan Koharmatau TNI AUSama dengan <strong>No</strong>. SuratB/327-09/20/06/Koharmatau1630 11/07/2<strong>01</strong>1 315/SK/SETWAN/2<strong>01</strong>0 Sekretaris DPRD Prov. NTT 02/11/11 16/11/11 16823566200<strong>03</strong>1631 11/07/2<strong>01</strong>1 4429.a/PL.210/L.1/7/11 Sekretaris Badan Karantina Pertanian Kem. Pertanian 02/11/11 21/11/11 168235689000<strong>01</strong>632 11/07/2<strong>01</strong>1 3/DST/PLP/VII/2<strong>01</strong>1 Corporate Manager Diponegoro Smart Solution 02/11/11 16/11/11 16823566600091633 11/07/2<strong>01</strong>1 PR.<strong>01</strong>.02.212.06.11.1227 Kabiro Perencanaan dan Keuangan Badan POM RI 28/10/11 16/11/11 16823568200071634 11/07/2<strong>01</strong>1 - an. Budi Hartono <strong>01</strong>/11/11 10/11/11 16823559900081635 11/07/2<strong>01</strong>1 UM.<strong>01</strong>.11-SL.04/121Kepala Balai Diklat Wilayah IV Surabaya PusdiklatSetjend Kementerian PU02/11/11 16/11/11 16823567800041636 12/07/2<strong>01</strong>1 800/190/Umkap/V/2<strong>01</strong>1Kabag Umum dan Perlengkapan Sekretariat DaerahPemkab Tanah Bumbu<strong>01</strong>/11/11 04/11/11 16823551900021637 12/07/2<strong>01</strong>1 B/4752/08/23/<strong>01</strong>/SET Kabag Umum Badan Sarana Pertahanan Kemhan <strong>01</strong>/11/11 04/11/11 16823552000081638 12/07/2<strong>01</strong>1 W3.TUN/309/KP.<strong>01</strong>/VI/2<strong>01</strong>1 Ketua Pengadilan Tinggi Tata Usaha Negara Surabaya <strong>01</strong>/11/11 09/11/11 16823558100091639 12/07/2<strong>01</strong>1 B/1009/VI/2<strong>01</strong>1Sekretaris Badan Penelitian dan PengembanganKementerian Pertahanan1640 12/07/2<strong>01</strong>1 308/RSU/2<strong>01</strong>1 Dir. RSU H. Sahudin Kutacane Kab. Aceh Tenggara 02/11/11 16/11/11 16823565500<strong>03</strong>Tidak ada fotocopysertifikat1641 12/07/2<strong>01</strong>1 233/07/PDAM/2<strong>01</strong>1 Dirut PDAM Tirta Daroy Kota Banda Aceh Sertifikat masih berlaku1642 12/07/2<strong>01</strong>1 652/J18.1/LL/2<strong>01</strong>1 Kepala LPMP Prov. NAD Kemdiknas 02/11/11 16/11/11 16823566900061643 12/07/2<strong>01</strong>1 KP.307/1/3/PPSDMA-2<strong>01</strong>11644 12/07/2<strong>01</strong>1 B.696/LATTAS-SES/VII/2<strong>01</strong>1Kapus Pengembangan SDM Aparatur PerhubunganBadan Pengembangan SDM Perhubungan KementerianPerhubunganSekretaris Direktorat Jenderal Pembinaan pelatihan danProduktivitas Kemenakertrans02/11/11 16/11/11 168235680000928/10/11 09/11/11 1682355860004Hal 79

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1645 12/07/2<strong>01</strong>1 B.07.02/BBAT.MDG/PL.610/VII/2<strong>01</strong>1Kepala Balai Budidaya Air Tawar Mandangin DirjendPerikanan Budidaya Kementerian Kelautan danPerikanan02/11/11 16/11/11 16823565400041646 13/07/2<strong>01</strong>1 <strong>027</strong>/775/437.33/2<strong>01</strong>1 Sekretaris Daeraj Pemkab Gresik 04/11/11 16/11/11 16823566800071647 13/07/2<strong>01</strong>1 S-514/WBC.02/KPP.04/2<strong>01</strong>11648 13/07/2<strong>01</strong>1 B/1411/VII/2<strong>01</strong>1Kepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe B Sibolga Kementerian Keuangan DitjenBea dan CukaiSekretaris Ditjend Kekuatan Pertahanan KementerianPertahanan1649 13/07/2<strong>01</strong>1 <strong>027</strong>/Speg/STIKES-SG/VII/2<strong>01</strong>1 Ketua STIKES Surya Global1650 13/07/2<strong>01</strong>1 700/542/Itko-Set/2<strong>01</strong>1 Inspektur Kota Pontianak 02/11/11 18/11/11 16823569900071651 13/07/2<strong>01</strong>1 893.5/PEM/590/VII/2<strong>01</strong>11652 13/07/2<strong>01</strong>1 B/977/VII/2<strong>01</strong>1Asisten Perekonomian dan Pembangunan Setda kotaBitungSekretaris Pusat Kesenjataan Infanteri Kodiklat TNIAD1653 13/07/2<strong>01</strong>1 B-37/R.4.1/Cu.3/07/2<strong>01</strong>1 Kepala Kejaksaan Tinggi Sulawesi Selatan1654 13/07/2<strong>01</strong>1 W31.PL.02.<strong>03</strong>-1004Kepala Kanwil Gorontalo Kementerian Hukum danHAM1655 13/07/2<strong>01</strong>1 800/961/Binpro/2<strong>01</strong>1 Sekretaris Daerah Pemkab Tasiklamaya02/11/11 11/11/11 16823561600041656 13/07/2<strong>01</strong>1 800/PU-BM/654 Kepala Bidang Bina Marga Dinas PU Pemprov Riau 31/10/11 11/11/11 1682356060007Tidak ada sosialisasi perpres54Persyaratan tidak lengkapTidak ada sosialisasi perpres54Persyaratan tidak lengkapTidak ada fotocopysertifikatPersyaratan tidak lengkapTidak ada fotocopysertifikat1657 14/07/2<strong>01</strong>1 608.8/ITJ.0/KP.150/VII/2<strong>01</strong>1 Sekretaris Inspektorat Jenderal Kementerian KP 02/11/11 11/11/11 16823562900081658 14/07/2<strong>01</strong>1 893/6342/I.1 Kepala Dinas Kesehatan Prov. DIYSudah pernah diajukankonversi dan Tidak adasosialisasi perpres 541659 14/07/2<strong>01</strong>1 B/739-1/VI/2<strong>01</strong>1 Kepala Sekretariat Umum Ankatan Darat Sertifikat masih berlaku1660 14/07/2<strong>01</strong>1 SM.006/<strong>01</strong>/11/SYB.Tpr.2<strong>01</strong>1Syahbandar Kelas Utama Tg. Perak Surabaya DitjenPerhubungan Laut Kementerian Perhubungan02/11/11 14/11/11 168235634000<strong>01</strong>661 14/07/2<strong>01</strong>1 520/PerHutPAn/VII/338Kepala Dinas Pertanian, Kehutanan dan KetahananPangan Pemkot Bitung02/11/11 16/11/11 16823565600021662 14/07/2<strong>01</strong>1 <strong>027</strong>.258/BPP-LKT/2<strong>01</strong>1 Kepala Bappeda Kab. Langkat 28/10/11 10/11/11 16823560500081663 14/07/2<strong>01</strong>1 <strong>03</strong>3/UN7.ULP/KP/2<strong>01</strong>1 Ketua ULP Univ. Diponegoro 31/10/11 10/11/11 168235597000<strong>01</strong>664 14/07/2<strong>01</strong>1 157/9.2-100.9/VII/2<strong>01</strong>1Kepala Pusat Pendidikan dan Pelatihan BadanPertanahan Nasional RI31/10/11 21/11/11 1682357650009Hal 80

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1665 14/07/2<strong>01</strong>1 <strong>027</strong>/1<strong>01</strong>3-BKPP Sekretaris Daerah Pemkot Bogor 28/10/11 09/11/11 16823558800021666 14/07/2<strong>01</strong>1 522/146/VII/2<strong>01</strong>1/Dishut Kepala Dinas Kehutanan Pemkab Mamuju Utara 02/11/11 14/11/11 16823563300<strong>01</strong>1667 14/07/2<strong>01</strong>1 020/438/PBJ-BP2MPBJ/VII/2<strong>01</strong>1 Sekretaris Daerah Kab. Dharmasraya 02/11/11 11/08/111668 15/07/2<strong>01</strong>1 524.4/464/Bang-Disnak 2<strong>01</strong>1Plh. Kepala Dinas Peternakan Pemprov. KalimantanSelatan02/11/11 16/11/11 168235658000<strong>01</strong>669 15/07/2<strong>01</strong>1 107/SET/PE/VII/2<strong>01</strong>1Sekretaris Dinas Pertambangan dan Energi Pemprov.Kep. Riau02/11/11 18/11/11 16823568500041670 15/07/2<strong>01</strong>1 050/2974/Adm.Pemb Kepala DPPKAD Setda Pemkab Pemalang 31/10/11 11/11/11 16823562400<strong>03</strong>1671 15/07/2<strong>01</strong>1 118/DPU/2<strong>01</strong>1 Sekretaris Dinas PU Pemkab Karimun Sudah pernah dikonversi1672 15/07/2<strong>01</strong>1 893/275/BPPPPK/SET-CKepala Bidang Penyuluhan Perikanan, BadanPelaksana Penyuluhan Pertanian, Perikanan danKehutanan Pemkab Kapuas HuluSudah pernah dikonversi1673 15/07/2<strong>01</strong>1 S-4<strong>03</strong>/BPP.05/2<strong>01</strong>1Kepala Balai Diklat Keuangan Yogyakarta, BadiklatKeuangan Kementerian Keuangan1674 15/07/2<strong>01</strong>1 PD.02<strong>03</strong>-Cb/627Direktur Penataan Bangunan dan Lingkungan DirjendCipta Karya Kementerian Pu (kasubang pu)15/09/11 12/10/11 16198922600041675 15/07/2<strong>01</strong>1 S-608/BL.<strong>01</strong>/UP.6/2<strong>01</strong>1Sekretaris Badan Pengawas Pasar Modal dan LembagaKeuangan<strong>03</strong>/11/11 21/11/11 16823569800081676 15/07/2<strong>01</strong>1 800/480-Set/DIPENPROVSekretaris Dinas Pendapatan Pemprov. KalimantanSelatan02/11/11 18/11/11 16823567300091677 15/07/2<strong>01</strong>1 S-6790/PB.1/2<strong>01</strong>1Sekretaris Ditjend Perbendaharaan KementerianKeuangan<strong>01</strong>/11/11 16/11/11 16823567100<strong>01</strong>1678 18/07/2<strong>01</strong>1 W21-U/933/UM.02.02/VII/2<strong>01</strong>1 Panitera/sekretaris Pengadilan Tinggi Sulawesi Tengah 31/10/11 09‐11‐2<strong>01</strong>1 1682355840006Tidak ada sosialisasi perpres54Sama dengan <strong>No</strong>. SuratPD.02<strong>03</strong>-cb/5111679 18/07/2<strong>01</strong>1 500/235/Ekobang Sekretaris Daerah Pemkot Palangkaraya 31/10/11 10/11/11 16823560400091680 18/07/2<strong>01</strong>1 900-2934/BPKAD/2<strong>01</strong>1Plt. Kepala Badan Pengelola Keuangan dan AsetDaerah Kab. Langkat02/11/11 16/11/11 16823565900091681 18/07/2<strong>01</strong>1 S.1497/SET-1/2<strong>01</strong>1Sekretaris Ditjend BPDAS dan Perhutanan SosialKementerian Kehutanan02/11/11 16/11/11 16823566400<strong>01</strong>1682 18/07/2<strong>01</strong>1 810/181/2<strong>01</strong>1Kepala Satuan Polisi Pamong Praja PemkabGunungkidul02/11/11 14/11/11 16823564500061683 18/07/2<strong>01</strong>1 B/400/VII/2<strong>01</strong>1Kepala Kesehatan Komando Cadangan Strategis TNIAD/DP<strong>03</strong>/11/11 11/11/11 16823561900<strong>01</strong>1684 18/07/2<strong>01</strong>1 183/UN33.9/PM/2<strong>01</strong>1 Sekretaris LPM Univ. Negeri Medan <strong>03</strong>/11/11 28/11/11 16823587200081685 18/07/2<strong>01</strong>1 <strong>01</strong>94/UN30.6/SA/2<strong>01</strong>1 Kajur Akuntansi Fakultas Ekonomi Univ. Bengkulu Sudah lulus ujian th.2<strong>01</strong>11686 18/07/2<strong>01</strong>1 020/459/PBJ-BP2MPBJ/VII/2<strong>01</strong>1 Setda Kab. DharmasrayaSama dengan <strong>No</strong>. SuratPD.02<strong>03</strong>-cb/511Hal 81

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1687 18/07/2<strong>01</strong>1 U.30/66/RRI-Mks/Sek/7/2<strong>01</strong>1 Kepala RRI Makassar <strong>03</strong>/11/11 09/11/11 168235580000<strong>01</strong>688 19/07/2<strong>01</strong>1 159/9.2-100.9/VII/2<strong>01</strong>11689 19/07/2<strong>01</strong>1 S.948/SET-2/2<strong>01</strong>11690 19/07/2<strong>01</strong>1 S.3520/BKSDA-1.2/2<strong>01</strong>1Kepala Pusat Pendidikan dan Pelatihan BadanPertanahan Nasional RIPlh. Setditjend Planologi Kehutanan KementerianKehutananKepala Balai Konservasi SDA Kalimantan TimurDitjend Perlindungan Hutan dan Konservasi AlamKementerian Kehutanan<strong>03</strong>/11/11 16/11/11 1682356810008<strong>01</strong>/11/11 04/11/11 1682355160005Sertifikat masih berlaku1691 19/07/2<strong>01</strong>1 21/IAPI/SP/VII/2<strong>01</strong>1 Wasesjend DPP IAPI <strong>01</strong>/11/11 04/11/111692 19/07/2<strong>01</strong>1 22/IAPI/SP/VII/2<strong>01</strong>1 Wasesjend DPP IAPI <strong>01</strong>/11/11 18/11/111693 20/07/2<strong>01</strong>1 800/1986/V/2<strong>01</strong>1 Setda Pemkab Banyuasin 31/10/11 14/11/11 16823562600<strong>01</strong>1694 20/07/2<strong>01</strong>1 Pb.045.2/502/2<strong>01</strong>1 Kepala Bagian Pembangunan Setda Pemkab Sikka 31/10/11 14/11/11 16823563000041695 20/07/2<strong>01</strong>1 130.04/1<strong>01</strong>/Adpemb/2<strong>01</strong>1 Sekretaris Daerah Kab. Lombok Timur <strong>03</strong>/11/11 09/11/11 16823559300041696 20/07/2<strong>01</strong>1 522/376/Dishut-2<strong>01</strong>1 Kepala Dinas Kehutanan Pemkab SijunjungSertifikat masih berlaku dansudah pernah dikonversi1697 20/07/2<strong>01</strong>1 <strong>027</strong>/1263-PembAsisten Sekda Bidang Perekonomian danPembangunan Setda Pemkab PurwakartaSudah pernah dikonversi1698 20/07/2<strong>01</strong>1 278/UP-RS/VII/2<strong>01</strong>1 Direktur RSUD Sambas Sudah pernah dikonversi1699 20/07/2<strong>01</strong>1 <strong>027</strong>/549/Kes/I/2<strong>01</strong>1 Kepala Dinas Kesehatan Prov. Sumatera Selatan <strong>03</strong>/11/11 15/11/11 16823564800<strong>03</strong>1700 20/07/2<strong>01</strong>1 W29.U4/60/KU/05.02/VII/2<strong>01</strong>1 Panitera/Sekretaris Pengadilan Negeri Tanggerang 04/11/11 05‐12‐2<strong>01</strong>1 168236095000417<strong>01</strong> 20/07/2<strong>01</strong>1 050/5762/Prog Direktur RSUD Gunungsitoli 04/11/11 21/11/11 16823576000041702 21/07/2<strong>01</strong>1 DL.5<strong>01</strong>/1/1/C.PTK-11Manager SDM, Umum & Pengadaan PT. PelabuhanIndonesia II (Persero) Cabang Pontianak17<strong>03</strong> 21/07/2<strong>01</strong>1 521/1005/KP.810/VII/2<strong>01</strong>1Kepala Dinas Pertanian, Peternakan dan PerikananKab. Barito Timur04/11/11 21/12/11 16823642000061704 21/07/2<strong>01</strong>1 188.41/1236/05/2<strong>01</strong>1 Sekretaris Daerah Pemkot Metro <strong>03</strong>/11/11 16/11/11 1682356530005Tidak ada sosialisasi perpres541705 21/07/2<strong>01</strong>1 246/082 Camat Sawah Besar <strong>03</strong>/11/11 11/11/11 16823561400061706 21/07/2<strong>01</strong>1 B/475/VII/2<strong>01</strong>1 Kepala Bekangdam VI/MulawarmanSertifikat masih berlaku danTidak ada sosialisasi perpres541707 21/07/2<strong>01</strong>1 Au/7593/Pegum.2<strong>01</strong>5/VII/2<strong>01</strong>1Sekretaris Direktorat Jenderal Perhubungan Udara,Kementerian Perhubungan<strong>03</strong>/11/11 21/11/11 1682356970009Hal 82

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1708 22/07/2<strong>01</strong>1 474/1502/206.412/2<strong>01</strong>1Kepala Badan Pemberdayaan Perempuan dan KeluargaBerencana (PPKB) Kab. Bojonegoro04/11/11 25/11/11 16823580700041709 22/07/2<strong>01</strong>1 273/S/XII.4/07/2<strong>01</strong>1 Plt. Kepala Pusdiklat BPK RI 04/11/11 11/11/11 16823562200051710 25/07/2<strong>01</strong>1 443.5/2665/DKK/VII/2<strong>01</strong>1 Kepala Dinas Kesehatan Kota Pemkot Balikpapan 04/11/11 10/11/11 16823559500021711 25/07/2<strong>01</strong>1 050/051/424.022/2<strong>01</strong>1 Sekretaris Daerah Pemkab Pasuruan Sertifikat masih berlakuKepala Dinas Koperasi, Perindustrian dan Perdagangan1712 25/07/2<strong>01</strong>1 5<strong>03</strong>/119.a/KOPERINDAG-C/VI/2<strong>01</strong>1 10/10/11 28/11/11 1682358320000Kab. Landak1713 25/07/2<strong>01</strong>1 9085/K14/LL/2<strong>01</strong>1 Direktur Politeknik Negeri Jember Kemdiknas 04/11/11 11/11/11 16823562100061714 25/07/2<strong>01</strong>1 893.3/282/Diklat-DKabid Diklat teknis dan fungsional Badiklat Pemprov.Kalimantan Barat1715 25/07/2<strong>01</strong>1 600/BM.P/VII/2<strong>01</strong>1/840Sekretaris Dinas Bina Marga dan Pengairan PemkabBengkalis19/11/11 20/10/111716 25/07/2<strong>01</strong>1 S-55<strong>03</strong>/PB.1/2<strong>01</strong>1Kepala Bagian Umum Sekretariat DitjendPerbendaharaan Kementerian Keuangan04/11/11 18/11/11 168235696000<strong>01</strong>717 25/07/2<strong>01</strong>1 PL.0<strong>03</strong>/1/1323-BSN Plt. Kepala Badan SAR Nasional <strong>03</strong>/11/11 11/11/11 16823561200081718 25/07/2<strong>01</strong>1 360/81/VII/BPBD1719 25/07/2<strong>01</strong>1 602/660/405.12/2<strong>01</strong>1Kepala Pelaksana Badan Penanggulangan BencanaDaerah Prov. MalukuAsisten Pemerintahan dan Kesejahteraan Rakyat SetdaPemkab Ponorogo02/11/11 18/11/11 16823567600061720 25/07/2<strong>01</strong>1 800-580/KESPOLLIN/2<strong>01</strong>1 Kepala Badan Kesbang, Pol dan Linmas Kab. Langkat <strong>03</strong>/11/11 11/11/11 16823561700<strong>03</strong>Sama dengan <strong>No</strong>. Surat893.3/1145/Diklat-DTidak ada sosialisasi perpres541721 25/07/2<strong>01</strong>1 <strong>027</strong>/0586 Kepala Badan Kesbangpol dan Linmas Aceh Sudah pernah dikonversi1722 25/07/2<strong>01</strong>1 550/124/VII/2<strong>01</strong>1Kepala Dinas Perhubungan, Pariwisata, Komunikasidan Informatika Pemkab Maluku Barat Daya1723 25/07/2<strong>01</strong>1 B/440/VII/2<strong>01</strong>1 Direktur Topografi Angkatan Darat MabesAD1724 25/07/2<strong>01</strong>1 B/5124/08/23/<strong>01</strong>/SETKepala Bagian Umum Sekretariat Badan SaranaPertahanan KEmhan<strong>03</strong>/11/11 16/11/11 16823566000051725 26/07/2<strong>01</strong>1 <strong>027</strong>/194/PB Plt. Sekretaris Daerah Pemkab Sambas <strong>03</strong>/11/11 14/11/11 16823563100<strong>03</strong>1726 26/07/2<strong>01</strong>1 TU.000/B1.40/2<strong>01</strong>1Plt. Kepala Dinas Kelautan dan Perikanan PemkabTimor Tengah Utara1727 26/07/2<strong>01</strong>1 800/I.1.258/BKD/VII/2<strong>01</strong>1 Kepala BKD Pemkab Kutai Kartanegara <strong>03</strong>/11/11 06‐12‐2<strong>01</strong>1 16823613900071728 26/07/2<strong>01</strong>1 893/1108/VII/BMP/2<strong>01</strong>1Kepala Dinas Bina Marga dan Pengairan PemkotPematangsiantar<strong>03</strong>/11/11 18/11/11 16823567400081729 26/07/2<strong>01</strong>1 B/615/VII/2<strong>01</strong>1 Kepala Dinas Sejarah Angkatan Darat MABESAD 29/11/11 07‐12‐2<strong>01</strong>1 1682362070007Sertifikat masih berlakuTidak ada fotocopysertifikatSertifikat masih berlaku1730 26/07/2<strong>01</strong>1 421.5/1208/14.08/2<strong>01</strong>1 Kepala Sekolah SMK NU Ma'arif Kudus Sertifikat masih berlakuHal 83

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1731 26/07/2<strong>01</strong>1 890/PU-UPTJKSDM/845 Sekretaris Dinas PU Pemprov. Riau <strong>03</strong>/11/11 14/11/11 16823563800061732 26/07/2<strong>01</strong>1 S-391/WPJ.31/KP.<strong>01</strong><strong>01</strong>/2<strong>01</strong>1Kepala KPP Pratama Mataram Barat Kanwil DJP NusaTenggara Dirjend Pajak Kementerian Keuangan1733 26/07/2<strong>01</strong>1 25/IAPI/SP/VII/2<strong>01</strong>1 Wasesjend DPP IAPI <strong>03</strong>/11/11 21/11/11Tidak ada sosialisasi perpres541734 26/07/2<strong>01</strong>1 26/IAPI/SP/VII/2<strong>01</strong>1 Wasesjend DPP IAPI <strong>03</strong>/11/11 06‐12‐2<strong>01</strong>11735 27/07/2<strong>01</strong>1 AP.050/299/VII/2<strong>01</strong>1 Wakil Bupati Manggarai Timur <strong>03</strong>/11/11 28/11/111736 27/07/2<strong>01</strong>1 358/BP2MPD-ULP/VII/2<strong>01</strong>1Kepala Badan Perizinan, Penanaman Modal danPromos Daerah Kab. Indragiri Hilir04/11/11 25/11/11 16823580600051737 27/07/2<strong>01</strong>1 <strong>027</strong>/3282/PBD Asisten Administrasi Setda Prov. Jawa Barat 07/11/11 22/11/11 168235757000<strong>01</strong>738 27/07/2<strong>01</strong>1 523/229/DIKAN/SET-C Plt. Kepala Dinas Perikanan Kab. Kapuas Hulu <strong>03</strong>/11/11 06‐12‐2<strong>01</strong>1 16823613400021739 27/07/2<strong>01</strong>1 524/178.a/36/2<strong>01</strong>1Kasubbag Umum Dinas Kelautan dan PerikananPemkab Tanggamus14/10/11 19/10/11 16198934500081740 27/07/2<strong>01</strong>1 200/DK.UKM.PP/1.2/VII/2<strong>01</strong>1Kepala Dinas Koperasi, UKM Perindustrian danPerdagangan Pemkab Majene28/12/11 1761047000000 Sertifikat masih berlaku1741 27/07/2<strong>01</strong>1 800/Dishub-Sek/409.a/V/2<strong>01</strong>1Kepala Dinas Perhubungan dan Pariwisata Pemprov.Gorontalo04/11/11 25/11/11 16823581100071742 27/07/2<strong>01</strong>1 <strong>027</strong>/372/BPI/2<strong>01</strong>1 Kepala Badan Pengelola Infrastruktur Prov. Papua 04/11/11 25/11/11 16823581600021743 28/07/2<strong>01</strong>1 <strong>027</strong>/5322/PEMB/VII/2<strong>01</strong>1 Plt. Sekretaris Daerah Pemkab Samosir 14/11/11 16823564300081744 28/07/2<strong>01</strong>1 B/752/VII/2<strong>01</strong>1 Aslog Paspampres Mabes TNI <strong>03</strong>/04/12 02<strong>01</strong>29004728 Sertifikat masih berlaku1745 28/07/2<strong>01</strong>1 800/994/DisnakertransKepala Dinas Tenaga Kerja dan TransmigrasiPemprov. Kalimantan Selatan04/11/11 21/11/11 168235672000<strong>01</strong>746 28/07/2<strong>01</strong>1 1245/FTP-UGM/LK/2<strong>01</strong>1 Kepala Kantor Administrasi FTP Univ. Gajahmada 29/09/11 04/10/111747 28/07/2<strong>01</strong>1 282/Dir-PCM/IV/2<strong>01</strong>1 Direktur PD. Pelabuhan Cilegon Mandiri 04/11/11 25/11/11 16823581200061748 28/07/2<strong>01</strong>1 2770/UN6.Q2/TU/2<strong>01</strong>1 Pembantu Dekan II FT Geologi Univ. Padjajaran 04/11/11 21/11/11 16823569200041749 28/07/2<strong>01</strong>1 -1750 29/07/2<strong>01</strong>1 PL.<strong>01</strong>.02/1795/2<strong>01</strong>1Satuan Kerja SNVT PJPA Kalimantan II Prov.Kalimantan Tengah Balai Wilayah Sungai KalimantanII Ditjen SDA Kementerian PUKasubag Administrasi Umum Politeknik KesehatanKemenkes Padang04/11/11 29/12/11 1761046410008Sudah pernah dikonversi1751 29/07/2<strong>01</strong>1 B/718/VII/2<strong>01</strong>1 Kepala Hubdam IX/Udayana <strong>03</strong>/04/12 PD0212691 Sertifikat masih berlaku1752 29/07/2<strong>01</strong>1 B/717/VII/2<strong>01</strong>1 Kepala Hubdam IX/Udayana 04/11/11 21/11/11 1682356830006Hal 84

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1753 29/07/2<strong>01</strong>1 B/1667/VII/2<strong>01</strong>1 Kepala RSPAD Gatsu Ditkesad 04/11/11 25/11/11 168235818000<strong>01</strong>754 <strong>01</strong>/08/2<strong>01</strong>1 893.3/1864/OR Sekretaris Daerah Kab. Sanggau 04/11/11 21/11/11 16823571200071755 <strong>01</strong>/08/2<strong>01</strong>1 W9.Ff-PL.02.<strong>03</strong>-1296Kepala Kantor Imigrasi Pati Kanwil JatengKementerian Hukum dan HAMKepala Kantor Administrator Pelabuhan Tanjung Intan1756 <strong>01</strong>/08/2<strong>01</strong>1 UM.0<strong>01</strong>/1/20/Ad.Tg.Intan-11 Cilacap Ditjen Perhubungan Laut, KementerianPerhubungan1757 <strong>01</strong>/08/2<strong>01</strong>1 050/3534 Sekretaris Daerah Pemkab Jepara04/11/11 21/11/11 168235694000228/10/11 04/11/11 16823550900051758 <strong>01</strong>/08/2<strong>01</strong>1 25/UN5.2.3.2/PPM/2<strong>01</strong>1 Ketua LPM universitas Sumatera Utara Kemdiknas 07/11/11 25/11/11 1682358130005Tidak ada sosialisasi perpres541759 <strong>01</strong>/08/2<strong>01</strong>1 870/1960/BKD Kepala BKD Pemkab Sleman 07/11/11 23/11/11 16823577300081760 <strong>01</strong>/08/2<strong>01</strong>1 522.0/615/VII/2<strong>01</strong>1Kepala Dinas Kehutanan dan Perkebunan PemkabLamandauSertifikat masih berlaku1761 <strong>01</strong>/08/2<strong>01</strong>1 11.B.<strong>01</strong>.<strong>01</strong>/442/2<strong>01</strong>1Kepala Dinas Peternakan Pemkab Timor TengahSelatan07/11/11 22/11/11 16823575500021762 <strong>01</strong>/08/2<strong>01</strong>1 800/3147/Dinkes Kepala Dinas Kesehatan Kab. Banggai <strong>03</strong>/11/11 18/11/11 16823567700051763 <strong>01</strong>/08/2<strong>01</strong>1 Kd.22.10/1/OT.00/498/2<strong>01</strong>1Kepala Kantor Kabupaten Tojo Una-Una KementerianAgama04/11/11 25/11/11 16823580800<strong>03</strong>1764 <strong>01</strong>/08/2<strong>01</strong>1 MTs.S.22.02/07/PP.00.5/111/2<strong>01</strong>1 + Kepala Kab. Donggala MTs.N Labuan KementerianMTs.22.07/1/Kp.00.1/116/2<strong>01</strong>1 Agama10/11/11 25/11/11 16823583600061765 <strong>01</strong>/08/2<strong>01</strong>1 Kd.22.09/1/Kp.00.1/1139 & Kepala Kantor Kab. Parigi Moutong Kementerian1212/2<strong>01</strong>1Agama07/11/11 25/11/11 16823580400071766 02/08/2<strong>01</strong>1 800/3492/AKP.Aset Sekretaris Daerah Prov. Bali Sudah pernah dikonversi1767 02/08/2<strong>01</strong>1 B/554/VII/2<strong>01</strong>1 Direktur Keuangan Angkatan Darat MABES AD <strong>03</strong>/04/12 PD021270<strong>01</strong>768 02/08/2<strong>01</strong>1 B/299/VII/2<strong>01</strong>1Kepala Peralatan Komando Cadangan Strategis TNIAD/DP1769 02/08/2<strong>01</strong>1 B/658/VII/2<strong>01</strong>1 Kepala Hubdam VI/Mulawarman07/11/11Tidak ada fotocopysertifikatTidak ada alamatpengirimanTidak ada sosialisasi perpres541770 02/08/2<strong>01</strong>1 028/263.Insp Pls. Inspektur Prov. Sulawesi Tenggara Sertifikat masih berlaku1771 02/08/2<strong>01</strong>1 1229/FTP-UGM/LK/2<strong>01</strong>1 Kepala Kantor Administrasi FTP Univ. Gajahmada 29/09/11 04/10/11 16823581400041772 02/08/2<strong>01</strong>1 0<strong>01</strong>/PKPHD-Ketua Pusat Kajian Produk Hukum Daerah Univ.Konversi/UNLAM/VIII/2<strong>01</strong>1 Lambung Mangkurat07/11/11 25/11/11 16823581400041773 <strong>03</strong>/08/2<strong>01</strong>1 800/586/2<strong>01</strong>1Kepala Dinas Kelautan, Perikanan dan Pertanian KotaLhokseumawe07/11/11 30/11/11 16823593000<strong>01</strong>1774 <strong>03</strong>/08/2<strong>01</strong>1 440/Sekr/2322/VII/2<strong>01</strong>1 Plh. Kepala Dinas Kesehatan Prov. Sulawesi Utara <strong>03</strong>/11/11 14/11/11 16823564600051775 <strong>03</strong>/08/2<strong>01</strong>1 B.341/BBLKI-SRA/VI/2<strong>01</strong>1Kepala BBLKI Serang Ditjend BinalattasKemenakertransSertifikat masih berlaku danTidak ada sosialisasi perpres54Hal 85

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1776 <strong>03</strong>/08/2<strong>01</strong>1 -Kepala Biro Umum Badan Pengawas Tenaga Nuklir(BAPETEN)1777 <strong>03</strong>/08/2<strong>01</strong>1 100/Pem.BB/84/III/2<strong>01</strong>1 Sekretaris DAErah Pemkab Bone Bolango 07/11/11 25/11/11 168235795000<strong>01</strong>778 04/08/2<strong>01</strong>1 <strong>027</strong>/3509/Litbang/I/2<strong>01</strong>1Kepala Badan Penelitian dan Pengembangan Prov.Sumatera Utara1779 04/08/2<strong>01</strong>1 050/1432/25/2<strong>01</strong>1Kepala Dinas PU, Energi dan Sumber Daya MineralKeb. Magelang1780 04/08/2<strong>01</strong>1 B.<strong>03</strong>.2/BalitbangKP.0/KP.450/08/2<strong>01</strong>1Sekretaris Balitbang KP Kementerian KP 07/11/11 21/11/11 168235764000<strong>01</strong>781 04/08/2<strong>01</strong>1 B/31<strong>01</strong>-09/20/86/slog Aslog Mabes TNI 04/11/11 25/11/11 16823583500071782 05/08/2<strong>01</strong>1 800/650/VIII/CAPIL.1/2<strong>01</strong>1Kepala Dinas Kependudukan dan Pencatatan SipilPemkab Kutai Kartanegara04/11/11 25/11/11 16823584200071783 05/08/2<strong>01</strong>1 UK.110/239/VIII/KUPP.Ba'a-2<strong>01</strong>1Kepala Kantor Unit Penyelenggara Pelabuhan Ba'aDitjend Perhubla Kementerian PerhubunganKepala Balai Besar Industri Agro Badan Pengkajian07/11/11 05‐12‐2<strong>01</strong>1 1682361<strong>03</strong>00021784 05/08/2<strong>01</strong>1 2138/Bd/BBIA/VIII/2<strong>01</strong>1Kebijakan, Iklim dan Mutu Industri Kementerian 07/11/11 25/11/11 16823583700051785 05/08/2<strong>01</strong>1 UM<strong>01</strong>11-Aq/671.2PerindustrianKepala Balai Besar Wilayah Sungai Serayu OpakDitjend SDA Kementerian PU07/11/11 25/11/11 16823579900061786 05/08/2<strong>01</strong>1 893.3/1968/35.73.4<strong>03</strong>/2<strong>01</strong>1 Kepala Badan Kepegawaian Daerah Pemkot Malang 07/11/11 25/11/11 16823584300061787 08/08/2<strong>01</strong>1 W14-A/1461/PP.00.4/VIII/2<strong>01</strong>1Panitera/Sekretaris Pengadilan Tinggi AgamaPontianak07/11/11 22/11/11 16823576100<strong>03</strong>1788 08/08/2<strong>01</strong>1 Kd.19.<strong>03</strong>/1/KU.00.2/515/2<strong>01</strong>1Kepala Kantor Kabupaten Lombok Timur KementerianAgama07/11/11 05‐12‐2<strong>01</strong>1 16823608700051789 08/08/2<strong>01</strong>1 660.1/106/BLH-A/VII/2<strong>01</strong>1 Kabid PDL Badan Lingkungan Hidup Pemkab Landak 11/11/11 21/11/11 16823569000061790 08/08/2<strong>01</strong>1 S-981/WPB.26/BG.<strong>01</strong><strong>01</strong>/2<strong>01</strong>1Kepala Kanwil Prov. Sulawesi Tengah DitjendPerbendaharaan Kementerian Keuangan1791 08/08/2<strong>01</strong>1 PL.108/<strong>01</strong>/<strong>01</strong>/AD.LBR-11Kepala Kantor Administrator Pelabuhan Lembar DitjenPerhubla Kementerian Perhubungan07/11/11 21/11/11 16823569100051792 08/08/2<strong>01</strong>1 800/617/BKD.IV/2<strong>01</strong>1Kepala Badan Kepegawaian dan Diklat Kab. OganKomering Ulu Selatan1793 08/08/2<strong>01</strong>1 525/1536/TU-2Kepala Dinas Perkebunan Pemprov. KalimantanSelatan07/11/11 05‐12‐2<strong>01</strong>1 16823610200<strong>03</strong>1794 08/08/2<strong>01</strong>1 800/783/TU/DPPK/2<strong>01</strong>1Kepala Dinas Pertanian Perikanan dan Kehutanan KotaPontianak07/11/11 05‐12‐2<strong>01</strong>1 168236099000<strong>01</strong>795 08/08/2<strong>01</strong>1 3575/H10.11/LK/2<strong>01</strong>1 Dekan FISIP Univ. Brawijaya Kemdiknas 07/11/11 05‐12‐2<strong>01</strong>1 16823608400081796 08/08/2<strong>01</strong>1 Setdakab/05/95/VII/2<strong>01</strong>1Asisten Administrasi Pembangunan, Ekonomi danKesra Setda Pemkab Bolaang Mongondow07/11/11 05‐12‐2<strong>01</strong>1 16823609700021797 08/08/2<strong>01</strong>1 10/IAPI/SP/VIII/2<strong>01</strong>1 Wasesjend DPP IAPI 07/11/11 25/11/11Persyaratan tidak lengkapSertifikat masih berlakuTidak ada sosialisasi perpres54Persyaratan tidak lengkapTidak ada fotocopysertifikatHal 86

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1798 08/08/2<strong>01</strong>1 1279/BBPPI/KP.525/VI/2<strong>01</strong>1Kepala Bagian Tata Usaha Balai Besar PengembanganPenangkapan Ikan (BBPPI) Ditjen Perikanan TangkapKementerian KP07/11/11 22/11/11 16823575400<strong>03</strong>1799 08/08/2<strong>01</strong>1 B-113/O.3.24/Cp.2/07/2<strong>01</strong>1 Kepala Kejaksaan Negeri Purworejo Sudah pernah dikonversi1800 08/08/2<strong>01</strong>1 B/620/VIII/2<strong>01</strong>1 Komandan Yonzipur 9/LLB Divif 1 Kostrad <strong>03</strong>/04/12 PD0212692Tidak melampirkanfotocopy sertifikat yangtelah habis masa berlakunya18<strong>01</strong> 08/08/2<strong>01</strong>1 523/261/VII/2<strong>01</strong>1 Kepala Dinas Kelautan dan Perikanan Pemkab Takalar 07/11/11 21/11/11 16823570700051802 08/08/2<strong>01</strong>1 B/362-a/VII/2<strong>01</strong>1/Divpropam PLH. KABAG RENMIN 07/11/11 21/11/11 168235771000<strong>01</strong>8<strong>03</strong> 09/08/2<strong>01</strong>1 960/UN50/TU/2<strong>01</strong>1 Rektor Univ. Bangka Belitung 07/11/11 22/11/11 16823575800091804 09/08/2<strong>01</strong>1 B-2678/N.2/Cu.3/07/2<strong>01</strong>1Asisten Pembinaan Kejaksaan Tinggi Sumatera Utara -Medan1805 09/08/2<strong>01</strong>1 800/497/VIII/2<strong>01</strong>1 Kepala Kantor Perwakilan Jakarta Prov. Sumut1806 09/08/2<strong>01</strong>1 021/109/Ekbang/VIII/2<strong>01</strong>1 Sekretaris Daerah Kota Makassar 04/11/11 28/11/11 16823587100091807 09/08/2<strong>01</strong>1 SM.108/4/8 Phb.2<strong>01</strong>1Kepala Biro Keuangan dan Perlengkapan SetjendKementerian Perhubungan1808 10/08/2<strong>01</strong>1 B/544/VIII/2<strong>01</strong>1 Kepala Kesdam VI/Mulawarman07/11/11 28/11/11 16823587300071809 10/08/2<strong>01</strong>1 635/UM/VIII/2<strong>01</strong>1 Kepala Biro Umum Setjend Kementerian Sosial 07/11/11 21/11/11 1682357620002Sudah pernah dikonversiTidak ada sosialisasi perpres54Tidak ada sosialisasi perpres541810 10/08/2<strong>01</strong>1 51513.252.1 Kepala BPS Prov. Bali 07/11/11 21/11/11 16823571000091811 10/08/2<strong>01</strong>1 387/DIR-MRT/VII/2<strong>01</strong>1Dir. Fungsi Korporasi dan Perencanaan PT. MassRapid Transit JakartaSudah pernah dikonversi1812 10/08/2<strong>01</strong>1 020/486/PBJ-BP2MPBJ/VII/2<strong>01</strong>1 Sekretaris Daerah Kab. Dharmasraya Persyaratan tidak lengkap1813 10/08/2<strong>01</strong>1 SM.106/1/20 Phb 2<strong>01</strong>1 Kabiro Umum Setjend Kemhub 04/11/11 21/11/11 16823569500<strong>01</strong>1814 10/08/2<strong>01</strong>1 800/388/Nakkan/2<strong>01</strong>1 Kadinas Peternakan dan Perikanan Kab. Musi Rawas Sertifikat masih berlaku1815 11/08/2<strong>01</strong>1 B-2432/N.6.16/Cp.07/2<strong>01</strong>1 Kepala Kejaksaan Negeri Lubuklinggau Sudah pernah dikonversi1816 11/08/2<strong>01</strong>1 550/406/Dishub-Um/VIII/2<strong>01</strong>1Kepala Dinas Perhubungan, Komunikasi danInformatika Kab. Katingan04/11/11 16/12/11 16823648600021817 11/08/2<strong>01</strong>1 440/286/TU-2/VIII/2<strong>01</strong>1 Sekretaris Dinas Kesehatan Pemkab Katingan 04/11/11 16/12/11 1682364760005Hal 87

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1818 11/08/2<strong>01</strong>1 KP.02.07/0<strong>01</strong>39.2/2<strong>01</strong>1Kepala Loka Penelitian dan Pengembangan KesehatanPengendalian Penyakit Bersumber Binatang CiamisBalitbang Kesehatan Kementerian Kesehatan04/11/11 21/11/11 1682357040008Kepala Dinas Kehutanan dan Perkebunan Pemkab1819 11/08/2<strong>01</strong>1 <strong>027</strong>/3505/2<strong>01</strong>104/11/11 21/11/11 16823569300<strong>03</strong>Aceh Utara1820 11/08/2<strong>01</strong>1 B/652/VII/2<strong>01</strong>1 Kepala Hubkostrad 04/11/11 Tidak ada alamat pengirim1821 11/08/2<strong>01</strong>1 A26-30/V.237-2407/47 dekan FISIP Univ. Brawijaya Kemdiknas 04/11/11 25/11/11 1682358<strong>01</strong>000<strong>01</strong>822 11/08/2<strong>01</strong>1 <strong>027</strong>/1069/406.021/2<strong>01</strong>1 Sekretaris Daerah Kab. Trenggalek 04/11/11 25/11/11 1682358<strong>03</strong>00081823 11/08/2<strong>01</strong>1 KW.14.1/KP.<strong>01</strong>.2/13927/2<strong>01</strong>1 Kepala Kanwil Prov. Kalbar Kementerian Agama Persyaratan tidak lengkap1824 12/08/2<strong>01</strong>1 Kw.24.1/2/KS.00/1191/2<strong>01</strong>1Kepala Kanwil Prov. Sulawesi Tenggara KementerianAgama04/11/11 25/11/11 16823583900<strong>03</strong>1825 12/08/2<strong>01</strong>1 1732/TU.1<strong>01</strong>/B3/2<strong>01</strong>1 Sekretaris Utama BKKBN 07/11/11 25/11/11 16823580200091826 12/08/2<strong>01</strong>1 B/1054/VIII/2<strong>01</strong>1 Kepala Kesdam IX/Udayana 04/11/11 21/11/11 16823571400051827 12/08/2<strong>01</strong>1 PL.00.02.1480 Direktur Poltekkes Makassar 04/11/11 21/11/11 16823576900051828 12/08/2<strong>01</strong>1 S.334/BUHT-5/2<strong>01</strong>1Direktur Bina Usaha Hutan Tanaman Ditjend BinaUsaha Kehutanan Kementerian Kehutanan04/11/11 21/11/11 16823576600081829 12/08/2<strong>01</strong>1 <strong>027</strong>/2730/Dalprog Sekretaris Daerah Kab. Karawang 04/11/11 21/11/11 16823576800061830 12/08/2<strong>01</strong>1 2880/TU.220/F5.F/08/2<strong>01</strong>1 Kepala Balai Besar Veteriner Denpasar 04/11/11 25/11/11 1682357980007Ketua LPPM Univ.Jenderal Soedirman (Unsoed)1831 12/08/2<strong>01</strong>1 4214/H.23.9/KS.00.<strong>01</strong>/2<strong>01</strong>104/11/11 25/11/11 1682358410008Kemdiknas1832 15/08/2<strong>01</strong>1 050/1765/419.61/2<strong>01</strong>1 Kepala Bappeda Kota Kediri Persyaratan tidak lengkap1833 15/08/2<strong>01</strong>1 893.3/683/VIII/2<strong>01</strong>1 Kepala Dinas PU Pemprov. Kalimantan Timur 04/11/11 21/11/11 16823575900081834 15/08/2<strong>01</strong>1 120.04/150Kepala Balai Pemberdayaan dan Pengawasan JasaKonstruksi Dincipkataru Prov. Jawa Tengah04/11/11 23/11/11 16823577600051835 15/08/2<strong>01</strong>1 S.943/VIII/SET-4/2<strong>01</strong>1Sekretaris Badan Penelitian dan PengembanganKehutanan Kementerian Kehutanan04/11/11 25/11/11 16823583400081836 15/08/2<strong>01</strong>1 02/LPPN/VIII/2<strong>01</strong>1Lembaga Pengembangan Pengetahuan Nusantara(LPPN)04/11/11 16/12/11 16823649200<strong>03</strong>1837 15/08/2<strong>01</strong>1 <strong>027</strong>/1094-BKPP/2<strong>01</strong>1 Sekretaris Daerah Pemkot Tanggerang Selatan 07/11/11 21/11/11 16823576700071838 15/08/2<strong>01</strong>1 893/2381/HubkominfoKepala Dinas Perhubungan Komunikasi danInformatika Kab. Badung07/11/11 25/11/11 16823579700081839 15/08/2<strong>01</strong>1 600/421/DPU-AG/VI/2<strong>01</strong>1 Kepala Dinas PU Pemkab Agam 07/11/11 25/11/11 1682357960009Hal 88

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1840 15/08/2<strong>01</strong>1 893/7197/I.1 Kepala Dinas Kesehatan Prov. DIY 07/11/11 25/11/11 16823580000<strong>01</strong>1841 16/08/2<strong>01</strong>1 B/2605/VIII/2<strong>01</strong>1 Asisten Logistik Kodam XVII/Cenderawasih TNI AD Persyaratan tidak lengkap1842 16/08/2<strong>01</strong>1 022/IAPI/SP/VIII/2<strong>01</strong>1 Wasesjend DPP IAPI Sertifikat masih berlaku1843 16/08/2<strong>01</strong>1 800/4530/RSDS/TU/2<strong>01</strong>1 Dir. RSUD Dokter Soedarso 07/11/11 25/11/11 16823578200061844 16/08/2<strong>01</strong>1 <strong>01</strong>0/PD.8/375/2<strong>01</strong>1Sekretaris Dinas Pendidikan Pemprov. SulawesiSelatan1845 18/08/2<strong>01</strong>1 UK.199/1/09/KUPP.BTA-11 Kepala Kantor Unit Penyelenggara Pelabuhan Bunta 07/11/11 25/11/11 16823584000091846 18/08/2<strong>01</strong>1 525/060/WSUTG/2<strong>01</strong>0Manajer Bid. SDM dan KHA PT. PLN WilayahSulawesi Utara, Sulawesi Tengah dan Gorontalo07/11/11 25/11/11 16823581000081847 18/08/2<strong>01</strong>1 In.07/B.1b/KP.02.<strong>03</strong>/306/2<strong>01</strong>1 IAIN Sumatera Utara 07/11/11 23/11/11 16823579200<strong>03</strong>Sertifikat masih berlaku1848 18/08/2<strong>01</strong>1 600/079/Pel/2<strong>01</strong>1 Kepala Bagian Pembangunan Setda Pemkab Bulungan 07/11/11 23/11/11 16823578900091849 18/08/2<strong>01</strong>1 B/114/VIII/2<strong>01</strong>1Perwira Pemegang Kas Gabrah Keuangan DaerahMiliter VI/Mulawarman1850 18/08/2<strong>01</strong>1 B/1839/VIII/2<strong>01</strong>1 Sekretaris Kodiklat TNI AD1851 18/08/2<strong>01</strong>1 B/DIK.5.1/7747/VIII/2<strong>01</strong>1/Rosarpras Karo Sarpras Polda Jawa Tengah 07/11/11 07‐12‐2<strong>01</strong>1 16823616600<strong>01</strong>1852 18/08/2<strong>01</strong>1 0<strong>01</strong>/PKPHD-Konversi/UNLAM/VIII/2<strong>01</strong>1Ketua Pusat Kajian Produk Hukum Daerah Univ.Lambung Mangkurat04/11/11 25/11/11 16823578000081854 19/08/2<strong>01</strong>1 500/492/2<strong>01</strong>1 Sekretaris Daerah Kab. Aceh Tenggara 07/11/11 16/11/11 16823567900<strong>03</strong>1855 19/08/2<strong>01</strong>1 Kw.05.1/./KP.02.3/6361/2<strong>01</strong>1Kabag Tata Usaha Kanwil Prov. Jambi KementerianAgama04/11/11 21/11/11 16823570500071856 19/08/2<strong>01</strong>1 KW.06.1/10/KP.<strong>01</strong>.2/.../2<strong>01</strong>1Kepala Kanwil Prov. Sumatera Selatan KementerianAgama04/11/11 28/12/11 17610469600081857 19/08/2<strong>01</strong>1 B/808/VIII/2<strong>01</strong>1 Kadiskal MABESAL 09/11/11 23/11/11 1682357910004Tidak ada fotocopysertifikatTidak ada sosialisasi perpres541858 19/08/2<strong>01</strong>1 4416/-078.62 Kepala Disnakertrans Prov. DKI Jakarta 04/11/11 05‐12‐2<strong>01</strong>1 16823608600061859 19/08/2<strong>01</strong>1 Kimtaru.05.A.<strong>01</strong>/469/TTS/2<strong>01</strong>1Kepala Dinas Permukiman dan Tata Ruang Kab. TimorTengah Selatan04/11/11 21/11/11 16823571100081860 19/08/2<strong>01</strong>1 763/149/2<strong>01</strong>1 Kepala SKPD Dinas PU Prov. Papua Barat 07/11/11 05‐12‐2<strong>01</strong>1 16823609600<strong>03</strong>1861 19/08/2<strong>01</strong>1 S-596/IJ.1/2<strong>01</strong>1 Sekretaris Irjend Kementerian Keuangan 04/11/11 21/11/11 16823570600061862 22/08/2<strong>01</strong>1 KP.02.02/I.IV/2408/2<strong>01</strong>1 Dirut RSUP Dr. Kariadi1863 22/08/2<strong>01</strong>1 094/2998/Dikpora-BKepala Dinas Pendidikan Pemuda dan Olahraga Kab.SanggauSertifikat masih berlaku danTidak ada sosialisasi perpres54Sertifikat masih berlakuHal 89

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1864 22/08/2<strong>01</strong>1 S.323/SET-4/2<strong>01</strong>1 Sekretaris Irjend Kementerian KehutananSertifikat masih berlaku danTidak ada sosialisasi perpres541865 22/08/2<strong>01</strong>1 420/1<strong>01</strong>1-set/Disdik/2<strong>01</strong>1 Kepala Dinas Pendidikan Prov. Kalimantan Selatan 07/11/11 18/11/11 16823568700021866 23/08/2<strong>01</strong>1 14/DST/PLP/VIII/2<strong>01</strong>1 Corporate Manager Diponegoro Smart Solution 07/11/11 18/11/11 16823567500071867 23/08/2<strong>01</strong>1 0<strong>03</strong>13/PL/08/2<strong>01</strong>1/ULP Kepala ULP Kementerian Luar Negeri 07/11/11 06‐12‐2<strong>01</strong>1 16823613300<strong>03</strong>1868 23/08/2<strong>01</strong>1 6681/UN12/LK/2<strong>01</strong>1 Rektor Univ. Samratulangi 07/11/11 18/11/11 16823567500071869 23/08/2<strong>01</strong>1 2125/PL16/LL/2<strong>01</strong>1 Direktur Politeknik Negeri Pontianak Kemdiknas 07/11/11 23/11/11 16823577900021870 23/08/2<strong>01</strong>1 B/5318/PEG/8/2<strong>01</strong>1Kabiro Kepegawaian Badan Pengusahaan KawasanPerdagangan Bebas dab Pelabuhan Bebas Batam11/11/11 22/11/11 16823575600<strong>01</strong>1871 23/08/2<strong>01</strong>1 <strong>03</strong>0/IAPI/SP/VIII/2<strong>01</strong>1 Wasesjend DPP IAPI 08/11/11 23/11/111872 23/08/2<strong>01</strong>1 029/IAPI/SP/VIII/2<strong>01</strong>1 Wasesjend DPP IAPI 08/11/11 21/11/111873 23/08/2<strong>01</strong>1 600/225/04/2<strong>01</strong>11874 23/08/2<strong>01</strong>1 UM<strong>01</strong><strong>03</strong>-BW/06Asisten Bidang Pemerintahan Setda Pemkab LampungBaratKepala Balai Besar Pelaksanaan Jalan Nasional VDitjend Bina Marga Kementerian PU1875 24/08/2<strong>01</strong>1 458/UN19.2/PL/2<strong>01</strong>1 Sekretaris Lemlit Univ. Riau 07/11/11 18/11/11 16823568600<strong>03</strong>Persyaratan tidak lengkapSudah pernah dikonversi1876 24/08/2<strong>01</strong>1 S.181/08/PSIK-PP/2<strong>01</strong>1 Pelaksana Harian PSIK 09/11/11 29/11/11 16823588600<strong>01</strong>1877 24/08/2<strong>01</strong>1 Set.VII/2/KP.07.6/6135/2<strong>01</strong>1Sekretaris Ditjend Penyelenggaraan Haji dan UmrahKementerian Agama07/11/11 28/11/11 16823583300091878 24/08/2<strong>01</strong>1 020/867 Sekretaris Daerah Pemkab Bireuen 08/11/11 25/11/11 16823578300051879 24/08/2<strong>01</strong>1 - Kepala Badiklat Prov. Sumatera Utara 07/11/11 23/11/11 168235788000<strong>01</strong>880 25/08/2<strong>01</strong>1 800/1716, 1717, 17181881 25/08/2<strong>01</strong>1 S.328/BPDAS.PP-1/2<strong>01</strong>1Kedinas Pendidikan, Pemuda dan Olahraga Prov.PapuaKepala Balai Pengelolaan Daerah Aliran Sungai Palu-Poso Ditjend Bina Pengelolaan DAS dan PerhutananSosial Kementerian Kehutanan07/11/11 30/11/11 16823588200051882 25/08/2<strong>01</strong>1 <strong>03</strong>/LPPN/IX/2<strong>01</strong>1Direktur Program Lembaga PengembanganPengetahuan Nusantara (LPPN)09/11/11 28/11/11 16823583100<strong>01</strong>1883 25/08/2<strong>01</strong>1 193/UN33.9/PM/2<strong>01</strong>1 Sekretaris LPM Univ. Negeri Medan 09/11/11 23/11/11 16823577800<strong>03</strong>Persyaratan tidak lengkap1884 25/08/2<strong>01</strong>1 30/UN.5.2.3.2/PPM/2<strong>01</strong>1 Ketua LPM universitas Sumatera Utara Kemdiknas 09/11/11 30/11/11 16823596900<strong>03</strong>Hal 90

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1885 26/08/2<strong>01</strong>1 - an. I Made Gama Sumerta Sertifikat masih berlaku1886 26/08/2<strong>01</strong>1 B/2160/VIII/2<strong>01</strong>1/Sarpras Waka Polda Sulawesi Utara 09/11/11 30/11/11 16823596600061887 26/08/2<strong>01</strong>1 - an. I Putu Agus SumartanandaTidak ada sosialisasi perpres541888 26/08/2<strong>01</strong>1 S-432/WBC.16/KPP.09/2<strong>01</strong>1Pj. Kepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe A3 Jayapura, Kanwil Maluku, Papua danPapua Barat Ditjen Bea dan Cukai Kementerian10/11/11 30/11/11 1682359710008Keuangan1889 05/09/2<strong>01</strong>1 SEK.4.PL.02.02-480Kepala Biro Perlengkapan Setjend KementerianHukum dan HAM10/11/11 23/11/11 16823578700<strong>01</strong>1890 05/09/2<strong>01</strong>1 050/317/419.48/2<strong>01</strong>1 Kepala Dinas PU Kota Kediri Sertifikat masih berlakuKakanwil Sulawesi Tengah Kementerian Hukum dan1891 05/09/2<strong>01</strong>1 W.26.PL.02.<strong>03</strong>-171309/11/11 23/11/11 16823578500<strong>03</strong>HAM1892 05/09/2<strong>01</strong>1 W12.U/38/Um.09/IV/2<strong>01</strong>1 Panitera/Sekretaris Pengadilan Tinggi Jawa Tengah Sudah pernah dikonversi1893 05/09/2<strong>01</strong>1 S-304/WPJ.22/KP.04<strong>01</strong>/2<strong>01</strong>1Kepala KPP Pratama Karawang Utara Kanwil DJPJabar II Ditjen Pajak Kementerian Keuangan11/11/11 30/11/11 16823596100<strong>01</strong>1894 05/09/2<strong>01</strong>1 005/417/416-111/2<strong>01</strong>1 Kepala Dinas Koperasi dan UMKM Kab. Mojokerto 11/11/11 30/11/11 16823597000091895 05/09/2<strong>01</strong>1 UM.007/9<strong>01</strong>/VIII/2<strong>01</strong>1 Kepala Kantor SAR XXIV MeraukeSertifikat masih berlaku danTidak ada sosialisasi perpres541896 05/09/2<strong>01</strong>1 328/083.11 Direktur RSUD Tarakan 11/11/11 25/11/11 16823578400041897 05/09/2<strong>01</strong>1 B/825/VIII/2<strong>01</strong>1/Sat II Waka Satuan II Pelopor Korps Brimob POLRI 08/11/11 23/11/11 16823577700041898 05/09/2<strong>01</strong>1 640/260/Setwan/2<strong>01</strong>1 Sekretaris DPRD Kab. Hulu Sungai Utara Sertifikat masih berlaku1899 05/09/2<strong>01</strong>1 2146/445/I-1/2<strong>01</strong>1 Dir. RSUD Bangkinang 08/11/11 29/11/11 16823588900081900 05/09/2<strong>01</strong>1 800/2243/PSDA-KB/2<strong>01</strong>1Kepala UPTPSDA Kualuh Barumun Dinas PSDAProv. Sumatera Utara09/11/11 30/11/11 168235902000819<strong>01</strong> 06/09/2<strong>01</strong>1 058/270/DPE/IX/2<strong>01</strong>1Kepala Dinas Pertambangan dan Energi PemkabGunung Mas08/11/11 29/11/11 16823589900051902 06/09/2<strong>01</strong>1 IK<strong>01</strong>06-Aq/733Kepala BBWS Serayu Opak Ditjen SDA KementerianPU08/11/11 29/11/11 168235896000819<strong>03</strong> 06/09/2<strong>01</strong>1 561/SJ.2/TU.210/VIII/2<strong>01</strong>1Kabiro Kepegawaian Setjend Kementerian Kelautandan Perikanan07/11/11 21/11/11 16823571300061904 06/09/2<strong>01</strong>1 Sti.13/K/HM.<strong>01</strong>/1463/2<strong>01</strong>1 Ketua STAIN Jurai Siwo Metro 07/11/11 21/11/11 16823568800<strong>01</strong>Hal 91

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1905 07/09/2<strong>01</strong>1 28/BPSDMKP.<strong>01</strong>/TU.210/IX/2<strong>01</strong>1Sekretaris Badan Pengembangan SDM Kelautan danPerikanan Kementerian Kelautan dan PerikananSudah pernah dikonversi1906 07/09/2<strong>01</strong>1 1869/TU.210/A4/8/2<strong>01</strong>1Kepala Biro Keuangan dan Perlengkapan KementerianPertanian07/11/11 06‐12‐2<strong>01</strong>1 168236143000<strong>01</strong>907 07/09/2<strong>01</strong>1 523.<strong>027</strong>/913/PTKepala Dinas Kelautan dan Perikanan Prov.Kalimantan Barat09/11/11 29/11/11 16823588500021908 07/09/2<strong>01</strong>1 800/274/IV/Peg Sekretaris Dinas PU Prov. Kalimantan Tengah 07/11/11 30/11/11 16823590900<strong>01</strong>1909 07/09/2<strong>01</strong>1 W3-A/1397/OT.1.<strong>01</strong>/VIII/2<strong>01</strong>1 Ketua Pengadilan Tinggi Agama Padang 09/11/11 30/11/11 16823591100061910 07/09/2<strong>01</strong>1 640/54/ADM.PEMB/VI/2<strong>01</strong>1 Sekretaris Daerah Kab. Luwu Persyaratan tidak lengkap1911 08/09/2<strong>01</strong>1 S-209/WPJ.07/KP.08<strong>01</strong>/2<strong>01</strong>1Kepala KPP Perusahaan Masuk Bursa Kanwil JakartaKhusus, Kem. Keu1912 08/09/2<strong>01</strong>1 <strong>027</strong>/1<strong>03</strong>8Kepala Badan Pemberdayaan Masyarakat Perempuandan Keluarga Berencana Pemkab Gunungkidul1913 08/09/2<strong>01</strong>1 874/KU.150/K.1/9/2<strong>01</strong>1Sekretaris Badan Ketahanan Pangan KementerianPertanian10/11/11 23/11/11 16823579400<strong>01</strong>1914 09/09/2<strong>01</strong>1 <strong>027</strong>/602/VII/PHB.2<strong>01</strong>1Kepala Dinas Perhubungan Komunikasi danInformatika Prov. Sulawesi Tenggara07/11/11 29/11/11 16823587800021915 09/09/2<strong>01</strong>1 050/1605/05/2<strong>01</strong>1 Sekretaris Daerah Pemkab Magelang 09/11/11 28/11/11 16823589300<strong>01</strong>1916 09/09/2<strong>01</strong>1 800/4913Kepala Badan Perencanaan Pembangunan Daerah KotaMedan1917 09/09/2<strong>01</strong>1 04/PD <strong>03</strong><strong>01</strong> PJN-WIL.IV/PB/2<strong>01</strong>1Kepala Satuan Kerja Pelaksanaan Jalan NasionalWilayah IV Prov. Papua Barat (Bintuni)10/11/11 23/11/11 16823579300021918 12/09/2<strong>01</strong>1 0<strong>01</strong>/VIII/2<strong>01</strong>1 an Yusri Gaus 10/11/11 23/11/11 1682357750006Tidak ada sosialisasi perpres54Tidak ada sosialisasi perpres54Sertifikat masih berlaku danTidak ada sosialisasi perpres541919 12/09/2<strong>01</strong>1 125/DTKTS/VI/2<strong>01</strong>1 an Nasruddin 10/11/11 30/11/11 16823596000021920 12/09/2<strong>01</strong>1 B/489/VIII/2<strong>01</strong>1 Komandan Kodim 1008/TanjungTidak melampirkanfotocopy sertifikat yangtelah habis masa berlakunya1921 12/09/2<strong>01</strong>1 S-351/WPJ.20/KP.08<strong>01</strong>/2<strong>01</strong>1Kepala KPP Pratama Jakarta Pasar Rebo, Kanwil DJPJaktim Ditjen Pajak, Kementerian Keuangan07/11/11 30/11/11 16823591000071922 12/09/2<strong>01</strong>1 18091.133 Kepala Badan Pusat Statistik Kab. Pesawaran 09/11/11 23/11/11 16823579300021923 12/09/2<strong>01</strong>1 800/541/2<strong>01</strong>1 Kepala Dinas Bina Marga Kab. Aceh Utara Sudah pernah dikonversi1924 12/09/2<strong>01</strong>1 231/DKCTT/IX/2<strong>01</strong>1Kepala Dinas Kependudukan, Catatan Sipil, TenagaKerja dan Transmigrasi Pemkab Soppeng09/11/11 30/11/11 16823596700051925 12/09/2<strong>01</strong>1 PL.02.05/P2JN-MU/2<strong>01</strong>1/92 Kepala SNVT P2JN Prov. Maluku Utara 09/11/11 30/11/11 1682359640008Hal 92

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1926 12/09/2<strong>01</strong>1 60/LMC.<strong>01</strong>/VIII/2<strong>01</strong>1 Direktur Lembaga Manajemen Cerdas (LMC) 09/11/11 30/11/11 16823594500<strong>03</strong>1927 13/09/2<strong>01</strong>1 <strong>027</strong>/1267/Penda/2<strong>01</strong>1 Kepala Dinas Pendapatan Prov. Sumatera Utara 09/11/11 30/11/11 16823594700<strong>01</strong>1928 13/09/2<strong>01</strong>1 B/536/VIII/2<strong>01</strong>1 Wakil Komandan Pusat Intelijen Mabes AD Persyaratan tidak lengkap1929 13/09/2<strong>01</strong>1 900/220/Keu Kepala Bagian Keuangan Setda Kab. Bangli 09/11/11 30/11/11 16823594600021930 13/09/2<strong>01</strong>1 PL-108/<strong>01</strong>/<strong>01</strong>/DNG.Sby-111931 13/09/2<strong>01</strong>1 S-219/WPJ.<strong>03</strong>/KP.06<strong>01</strong>/2<strong>01</strong>1Kepala Distrik Navigasi Kelas I Surabaya DitjendPerhubungan Laut Kementerian PerhubunganKepala KPP Pratama Pangkal Pinang Kanwil DJPSumsel dan Kepulauan Babel Ditjen PajakKementerian KeuanganPersyaratan tidak lengkapTidak ada surat keterangankehilangan dari kepolisian1932 13/09/2<strong>01</strong>1 800/7496/IX/2<strong>01</strong>1 Kepala Dinas Kesehtanan Kab. Sukoharjo 09/11/11 29/11/11 16823587700<strong>03</strong>1933 14/09/2<strong>01</strong>1 B/1091/VIII/2<strong>01</strong>1 Asisten Logistik Kodam V Brawijaya TNI AD 09/11/11 07‐12‐2<strong>01</strong>1 16823618600051934 14/09/2<strong>01</strong>1 800/812.1/Sekrt.1/BKBPPKepala Badan Keluarga Berencana dan PemberdayaanPerempuan Kab. Barito Timur09/11/11 28/11/11 16823589500091935 14/09/2<strong>01</strong>1 600/377/DPU-BT/IX/2<strong>01</strong>1PLT. Kepala Dinas Pekerjaan Umum Kab. BaritoTimur09/11/11 28/11/11 16823589100<strong>03</strong>1936 14/09/2<strong>01</strong>1 5217/B.04/09/2<strong>01</strong>1Kepala Biro Perencanaan, Organisasi dan Tata LaksanaBappenas08/11/11 29/11/11 16823588400<strong>03</strong>1937 14/09/2<strong>01</strong>1 602/UPTD-DBM.GT/1320/2<strong>01</strong>1Kepala UPTD Gunungtua Dinas Bina Marga Pemprov.Sumatera Utara10/11/11 22/11/11 16823570900<strong>03</strong>1938 14/09/2<strong>01</strong>1 <strong>027</strong>/BPDA/30/VIII/2<strong>01</strong>1 Kepala Bappeda Prov. Sulawesi Tenggara 08/11/11 29/11/11 16823589800061939 14/09/2<strong>01</strong>1 890/629Kepala Dinas Pengelolaan Kekayaan Daerah PemkabSleman07/11/11 29/11/11 16823587900<strong>01</strong>1940 14/09/2<strong>01</strong>1 S-550/WBC.14/KPP.04/2<strong>01</strong>1Kepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe A3 Tarakan Kanwil Kalimantan BagianTimur Ditjend Bea dan Cukai Kementerian KeuanganTidak ada fotocopysertifikat1941 14/09/2<strong>01</strong>1 <strong>027</strong>/1222/Bina Program/2<strong>01</strong>1 Sekretaris Daerah Kab. Karo 08/11/11 29/11/11 168235887000<strong>01</strong>942 15/09/2<strong>01</strong>1 090.09/PSIK-PP/2<strong>01</strong>11943 15/09/2<strong>01</strong>1 B.1844/SJ.4/PL.120/VIII/2<strong>01</strong>1Pelaksana Program Pusat Studi Investasi dan Keuangan(PSIK)Kepala Biro Hukum dan Organisasi SetjendKementerian Kelautan dan Perikanan1944 15/09/2<strong>01</strong>1 640/437/DCK/IX/2<strong>01</strong>1 Kepala Dinas Karya Kab. Lebak07/11/11 29/11/11 168235876000407/11/11 30/11/11 1682359650007Sudah pernah dikonversidan Tidak ada sosialisasiperpres 541945 15/09/2<strong>01</strong>1 800/308/PU.BM/2<strong>01</strong>1 Kepala Dinas PU Bina Marga Kab. Musi Banyuasin 08/11/11 30/11/11 16823597200071946 16/09/2<strong>01</strong>1 800/1444/DKP-KS/B-II/IX/2<strong>01</strong>1Kepala Dinas Kebersihan dan Pertamanan PemkotSamarindaTidak ada sosialisasi perpres54Hal 93

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1947 16/09/2<strong>01</strong>1 050/887/IX/2<strong>01</strong>1Kepala Bidang Perikanan Dinas Peternakan, Kelautandan Perikanan Pemkab Kendal1948 16/09/2<strong>01</strong>1 Kd.17.08/KU.00.2/1513/2<strong>01</strong>1Kepala Kantor Kementerian Agama Kab. Hulu SungaiUtara1949 16/09/2<strong>01</strong>1 S-608A/KF.1/UP.6/2<strong>01</strong>1Sekretaris Badan Kebijakan Fiskal KementerianKeuangan09/11/11 29/11/11 16823588800091950 16/09/2<strong>01</strong>1 050/463/430.10.9/2<strong>01</strong>1Plt. Kepala Dinas Peternakan dan Perikanan Kab.Bondowoso08/11/11 28/11/11 16823583000021951 16/09/2<strong>01</strong>1 900/02/1/DISHUB KOMINFOKepala Dinas Perhubungan Komunikasi danInformatika Prov. Sumsel09/11/11 29/11/11 16823587500051952 16/09/2<strong>01</strong>1 060/268.1/IX/ULP/2<strong>01</strong>1 Kepala ULP Pemkot Bontang 09/11/11 29/11/11 16823589700071953 19/09/2<strong>01</strong>1 050/900/BKPP/2<strong>01</strong>11954 19/09/2<strong>01</strong>1 <strong>027</strong>/1159/35.09.311/2<strong>01</strong>1Kepala Badan Ketahanan Pangan dan Penyuluhan(BKPP)Kepala Badan Pemberdayaan Perempuan dan KeluargaBerencana (BPPKB) Kab. Jember09/11/11 30/11/11 1682359000000Sertifikat masih berlakuTidak ada sosialisasi perpres5409/11/11 Tidak ada alamat pengirim1955 19/09/2<strong>01</strong>1 <strong>027</strong>/86/<strong>01</strong>.2.002/2<strong>01</strong>1 Lurah Sempursari Kec. Kaliwates Keb. Jember 12/<strong>03</strong>/12 PD0208669 Tidak ada alamat pengirim1956 19/09/2<strong>01</strong>1 <strong>027</strong>/290/35.09.513/2<strong>01</strong>1 Kepala Kantor Pemuda dan Olahraga Kab. Jember 09/11/11 Tidak ada alamat pengirim1957 19/09/2<strong>01</strong>1 <strong>027</strong>/247/35.09.424/2<strong>01</strong>1 Sekretaris Dinas Pasar Pemkab Jember 09/11/11 Tidak ada alamat pengirim1958 19/09/2<strong>01</strong>1 Sti.13/K/HM.<strong>01</strong>/1540/2<strong>01</strong>1 Ketua STAIN Jurai Siwo Metro Sudah pernah dikonversi1959 20/09/2<strong>01</strong>1 W23.U5-1143/PL.08/IX/2<strong>01</strong>1 Pengadilan Negeri Unaaha 09/11/11 30/11/11 16823590400061960 20/09/2<strong>01</strong>1 <strong>027</strong>/24 Dinas Pekerjaan Umum Pemprov Maluku Persyaratan tidak lengkap1961 20/09/2<strong>01</strong>1 159/Seskab-002.434826/VIII/2<strong>01</strong>1Sekretaris Komisi Pemilihan Umum (KPU) Kab.Mandailing Natal10/11/11 22/11/11 16823570800041962 20/09/2<strong>01</strong>1 - RSUD Pemkab Kepulauan Talaud Sertifikat masih berlaku1963 20/09/2<strong>01</strong>1 B-1298/KP3K.0/VIII/2<strong>01</strong>1Sekretaris Ditjend Kelautan, Pesisir dan Pulau-PulauKecil06/10/111964 20/09/2<strong>01</strong>1 - an Abdul Haris 09/11/11 30/11/11 1682359<strong>03</strong>00071965 20/09/2<strong>01</strong>1 <strong>027</strong>/720/Ekbang.B/2<strong>01</strong>1 Setdakot Pontianak1966 21/09/2<strong>01</strong>1 271/-077.92 Kepala Balai Latihan Kerja Daerah Jakarta Pusat 07/11/11 21/11/11 1682357720009Tidak ada sosialisasi perpres541967 21/09/2<strong>01</strong>1 600/2672/PU 2<strong>01</strong>1 Kepala Dinas PU Kab. Kapuas 07/11/11 23/11/11 16823578600021968 21/09/2<strong>01</strong>1 800/1053/BKPPD 2<strong>01</strong>1 Kepala Badan Kepegawaian Diklat Kab. Kapuas 07/11/11 30/11/11 16823597400051969 21/09/2<strong>01</strong>1 893.3/0841 Kepala BKD Pemkab Semarang 07/11/11 24/11/11 16823581700<strong>01</strong>Hal 94

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1970 21/09/2<strong>01</strong>1 W25-U/277/PP.<strong>01</strong>.3/IX/2<strong>01</strong>1 Panitera/Sekretaris Pengadilan Tinggi Mataram 07/11/11 30/11/11 16823597300061971 21/09/2<strong>01</strong>1 B.1109/Setda/Umum/<strong>027</strong>/09/2<strong>01</strong>1 Sekretaris Daerah Pemkab Tabalong 09/11/11 30/11/11 16823590600041972 21/09/2<strong>01</strong>1 600/409/DPU/IX/2<strong>01</strong>1 Kepala Dinas PU Kab. Pulang Pisau Sertifikat masih berlaku1973 21/09/2<strong>01</strong>1 P.772/K/IX/2<strong>01</strong>11974 21/09/2<strong>01</strong>1 890/250/Diklat/2<strong>01</strong>1KPA/PPK Satker Pengembangan Perkeretaapian JawaBaratKepala Badan Kepegawaian diklat Kab. Aceh BaratDaya09/11/11 30/11/11 16823590700<strong>03</strong>1975 22/09/2<strong>01</strong>1 10/IAPI/SP/IX/2<strong>01</strong>1 Wasesjend DPP IAPI 07/11/11 25/11/111976 22/09/2<strong>01</strong>1 PL.108/<strong>01</strong>/<strong>01</strong>/DNG.Sby-11Kepala Distrik Navigasi Kelas I Surabaya DitjendPerhubungan Laut Kementerian Perhubungan1977 22/09/2<strong>01</strong>1 190/DPU/IX/2<strong>01</strong>1 Plt. Kepala Dinas PU Kab. Kepulauan Talaud09/11/11 30/11/11 16823597600<strong>03</strong>1978 22/09/2<strong>01</strong>1 PH.329/<strong>01</strong>/07/UPP.Lbn-11Kepala Kantor Unit Penyelenggara Pelabuhan LabuanBanten07/11/11 28/11/11 16823586500081979 22/09/2<strong>01</strong>1 W2-A/2258/KP.05.8/IX/2<strong>01</strong>1 Wakil Ketua Pengadilan Tinggi Agama Medan 07/11/11 30/11/11 1682359750004Tidak ada sosialisasi perpres54Tidak ada fotocopysertifikat1980 22/09/2<strong>01</strong>1 640/353/DPUK/IX/2<strong>01</strong>1 Kepala Dinas PU Kab. Bulungan 07/11/11 28/11/11 16823586800051981 22/09/2<strong>01</strong>1 S-664/IJ.1/2<strong>01</strong>1Sekretaris Inspektorat Jenderal Kementerian KeuanganRI09/11/11 05/12/11 16823607900061982 22/09/2<strong>01</strong>1 050/12/Pemb-II/IX/2<strong>01</strong>1 Asisten Ekonomi dan Pembangunan Kab. Nunukan 09/11/11 30/11/11 168236<strong>03</strong>50002Kepala Balai Diklat Transportasi Laut BPSDM1983 26/09/2<strong>01</strong>1 B.2710/KP.405/IX/BPPTL-2<strong>01</strong>109/11/11 05‐12‐2<strong>01</strong>1 1682360260004Perhubungan Kementerian Perhubungan1984 26/09/2<strong>01</strong>1 028/1863/Dindik/Sekr/IX/2<strong>01</strong>1 Kepala Dinas Pendidikan Kota Pangkalpinang Persyaratan tidak lengkap1985 26/09/2<strong>01</strong>1 B/2005/IX/2<strong>01</strong>1 Sekretaris Komandan Kodiklat TNI AD 04/04/12 PD0212745Tidak ada fotocopysertifikat1986 26/09/2<strong>01</strong>1 S-1544/WPB.24/KP.0810/2<strong>01</strong>1Pjs. Kepala Kantor Pelayanan Perbendaharaan Negara(KPPN) Watampone Kanwil Prov. Sulawesi SelatanDitjend Perbendaharaan Kementerian KeuanganSertifikat masih berlaku1987 26/09/2<strong>01</strong>1 168/Dishub.550/09/11 Kepala Dinas Perhubungan Kab. Kepulauan Anambas 09/11/11 06‐12‐2<strong>01</strong>1 16823615900<strong>01</strong>1988 27/09/2<strong>01</strong>1 005/43-04/2<strong>01</strong>1Asisten Administrasi Pembangunan dan KesejahteraanRakyat09/11/11 10/<strong>01</strong>/12 02<strong>01</strong>192953141989 27/09/2<strong>01</strong>1 810/720/Adm.Pemb Sekretaris Daerah Kab. Bangli 09/11/11 30/11/11 168236<strong>03</strong>7000<strong>01</strong>990 27/09/2<strong>01</strong>1 HK.<strong>01</strong>.13/SNVT-PJPA-KT/VIII/280Kepala Satker SNVT PJPA Kalimantan II Prov.Kalimantan Tengah Balai Wilayah Sungai KalimantanII Ditjen SDA Kementerian PUSudah pernah dikonversiHal 95

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>1991 27/09/2<strong>01</strong>1 S.1918/BTNMB-1/2<strong>01</strong>1Kepala Balai Taman Nasional Meru Betiri DitjenPerlindungan Hutan dan Konservasi Alam KementerianKehutanan1992 27/09/2<strong>01</strong>1 Stk.02/KP.08.8/397/2<strong>01</strong>1Ketua Sekolah Tinggi Agama Kristen Protestan NegeriAmbon1993 27/09/2<strong>01</strong>1 800/537/IX/2<strong>01</strong>1/BudparKepala Dinas Kebudayaan dan Pariwisata PemkabKepulauan Selayar1994 27/09/2<strong>01</strong>1 0<strong>03</strong>62/PL/09/2<strong>01</strong>1/ULPKepala ULP Sekretaris Jenderal Kementerian LuarNegeri1995 27/09/2<strong>01</strong>1 Ma.11.51/PP.00.6/509/2<strong>01</strong>1 Kepala MAN Babakan Kebaksiu Tegal09/11/11 30/11/11 168236<strong>01</strong>1000209/11/11 06‐12‐2<strong>01</strong>1 168236145000809/11/11 30/11/11 16823597800<strong>01</strong>1996 28/09/2<strong>01</strong>1 S-4309/WPJ.19/KP.04/2<strong>01</strong>1 Kepala Kantor KPP Wajib Pajak Besar Orang Pribadi 09/11/11 30/11/11 1682359800006Sudah pernah dikonversiTidak ada sosialisasi perpres541997 28/09/2<strong>01</strong>1 B/1822/IX/2<strong>01</strong>1 Kastaf Kodam II / Sriwijaya TNIAD Persyaratan tidak lengkap1998 28/09/2<strong>01</strong>1 213/SRT/K3/PJKA/IX/2<strong>01</strong>1Direktur Prasarana Perkeretaapian DitjendPerkeretaapian Kementerian Perhubungan09/11/11 06‐12‐2<strong>01</strong>1 16823614900041999 28/09/2<strong>01</strong>1 640/70/ADM.PEMB/IX/2<strong>01</strong>1 Sekretaris Daerah Pemkab Luwu 09/11/11 02‐12‐2<strong>01</strong>1 16823599200<strong>01</strong>2000 28/09/2<strong>01</strong>1 445/RSKD/993/2<strong>01</strong>1Direktur RS Khusus Daerah Kelas A Prov. SulawesiUtara20<strong>01</strong> 28/09/2<strong>01</strong>1 UM.02.05/PJN/WIL II/2<strong>01</strong>1/163 Kepala Satker Pelaksanaan Jalan Ansional Prov. Riau 09/11/11 07‐12‐2<strong>01</strong>1 1682361820009Tidak ada sosialisasi perpres542002 28/09/2<strong>01</strong>1 - an. Saikun Budihartono 09/11/11 10/11/1120<strong>03</strong> 28/09/2<strong>01</strong>1 W5.Ea5.UM.10.10-274Kepala Rutan Kelas I Palembang Kanwil SemateraSelatan Kementerian Hukum dan HAM2004 28/09/2<strong>01</strong>1 800/643/435.109/2<strong>01</strong>1 Kepala Dinas PU Pengairan Kab. Sumenep 09/11/11 06‐12‐2<strong>01</strong>1 1682361510009Sertifikat masih berlaku2005 28/09/2<strong>01</strong>1 W25-U2/1518/PP.<strong>01</strong>.3/IX/2<strong>01</strong>1 Ketua Pengadilan Negeri Sumbawa Besar 09/11/11 06‐12‐2<strong>01</strong>1 16823614800052006 28/09/2<strong>01</strong>1 100/Progdal/2<strong>01</strong>1/<strong>03</strong> Asisten Bidang Ekbang Seta Pemkab Rokan Hilir 09/11/11 11/<strong>01</strong>/12 TIKI2007 30/09/2<strong>01</strong>1 800/768-ADPEM/2<strong>01</strong>1 Sekretaris Daerah Pemkot Serang 10/11/11 05‐12‐2<strong>01</strong>1 16823608800042008 30/09/2<strong>01</strong>1 895.3/3227 Sekretaris Daerah Kota Sabang 07/11/11 30/11/11 16823596200002009 30/09/2<strong>01</strong>1 2<strong>03</strong>/UN33.9/PM/2<strong>01</strong>1 Ketua LPM Universitas Negeri Medan (UNIMED) 10/11/11 30/11/11 16823588300042<strong>01</strong>0 30/09/2<strong>01</strong>1 469/BPSDMKP.<strong>01</strong>/TU.210/IX/2<strong>01</strong>1Sekretaris BPSDMKP Kementerian Kelautan danPerikanan10/11/11 30/11/11 16823597700022<strong>01</strong>1 30/09/2<strong>01</strong>1 526/733/9/2<strong>01</strong>1Kepala Badan Ketahanan Pangan dan Penyuluhan(BKPP) Pemerintah Aceh10/11/11 06‐12‐2<strong>01</strong>1 16823616100062<strong>01</strong>2 30/09/2<strong>01</strong>1 810/1125/DPU Kepala Dinas PU Kab. Bangli 10/11/11 06‐12‐2<strong>01</strong>1 1682361630004Hal 96

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2<strong>01</strong>3 30/09/2<strong>01</strong>1 Dj/Set.VII/2/KP.07.6/7339/2<strong>01</strong>1Sekretaris Ditjend Penyelenggaraan Haji dan UmrahKementerian Agama10/11/11 28/11/11 16823583300092<strong>01</strong>4 30/09/2<strong>01</strong>1 800/1426/RSUD Direktur RSUD Pemkab Klungkung 10/11/11 05‐12‐2<strong>01</strong>1 16823600000062<strong>01</strong>5 30/09/2<strong>01</strong>1 196/9.2-100.9/IX/2<strong>01</strong>1 Kepala Pusdiklat BPN 11/11/11 29/11/11 16823589000042<strong>01</strong>6 30/09/2<strong>01</strong>1 99/PL3/LL/2<strong>01</strong>1Direktur Politeknik Negeri Jakarta KementerianPendidikan Nasional11/11/11 02‐12‐2<strong>01</strong>1 16823599000<strong>03</strong>2<strong>01</strong>7 30/09/2<strong>01</strong>1 PJPP.600.895.5/310/IX/2<strong>01</strong>1Kepala Dinas Prasarana Jalan Dn PengembanganPengairan Kab. Timor Tengah Selatan10/11/11 05‐12‐2<strong>01</strong>1 16823602900<strong>01</strong>2<strong>01</strong>8 30/09/2<strong>01</strong>1 602.3/325/SEK/DISBIMAIRKepala Dinas Bina Marga & Pengairan PemkabBanggai11/11/11 02‐12‐2<strong>01</strong>1 168236<strong>01</strong>900042<strong>01</strong>9 30/09/2<strong>01</strong>1 169/B2TP-BPPT/IX/2<strong>01</strong>1 Kepala Balai Besar Teknologi Pati - BPPT 10/11/11 07‐12‐2<strong>01</strong>1 16823626300<strong>03</strong>2020 30/09/2<strong>01</strong>1 800/650/BKB & KS/2<strong>01</strong>1 Kepala Badan KB & KS Kab. Wajo 10/11/11 07‐12‐2<strong>01</strong>1 16823626400022021 28/09/2<strong>01</strong>1 D.07/Perhub/14/IX/2<strong>01</strong>1 Kepala Dinas Perhubungan Pemkot Manado 10/11/11 06‐12‐2<strong>01</strong>1 16823615000002022 <strong>03</strong>/10/2<strong>01</strong>1 050/168/APP/2<strong>01</strong>1 Sekdakab DompuSertifikat masih berlaku danTidak ada sosialisasi perpres542023 <strong>03</strong>/10/2<strong>01</strong>1 600/4569/IX/Minbang/LK-2<strong>01</strong>1 Sekda Kab. Lima Puluh Kota 09/11/11 02‐12‐2<strong>01</strong>1 16823598800082024 <strong>03</strong>/10/2<strong>01</strong>1 PU.600/292/KK/2<strong>01</strong>1 Kepala Dinas PU Kota Kupang Sertifikat masih berlaku2025 <strong>03</strong>/10/2<strong>01</strong>1 - Alfaris Labagu2026 04/10/2<strong>01</strong>1 600/439/DPU Kepala Dinas PU Kab. Barito Kuala 11/11/11 30/11/11 16823598300<strong>03</strong>Tidak ada sosialisasi perpres542<strong>027</strong> 04/10/2<strong>01</strong>1 800/743/D.2/DIKLAT Badiklat Pemprov Bengkulu 11/11/11 30/11/11 1682359<strong>01</strong>00092028 04/10/2<strong>01</strong>1 890/202/Bid.III/Dis.HKF 2<strong>01</strong>1Kepala Dinas Perhubungan, Komunikasi danInformatika Pemkab Rejang Lebong09/11/11 02‐12‐2<strong>01</strong>1 16823598400022029 04/10/2<strong>01</strong>1 18840/J1.1/LL/2<strong>01</strong>1Sekretaris BPSDM Pendidikan dan Penjaminan MutuPendidikan09/11/11 02‐12‐2<strong>01</strong>1 16823598700092<strong>03</strong>0 04/10/2<strong>01</strong>1 IK<strong>01</strong>06-Ax.0902/1271Kepala Balai Besar Wilayah Sungai Citanduy DitjendSDA Kementerian PU09/11/11 02‐12‐2<strong>01</strong>1 16823600500<strong>01</strong>2<strong>03</strong>1 04/10/2<strong>01</strong>1 4426/PL1.R/LK/2<strong>01</strong>1 Direktur Politeknik Negeri Bandung 10/11/11 28/11/11 16823586600072<strong>03</strong>2 04/10/2<strong>01</strong>1 600/163/DPUD/IX/2<strong>01</strong>1 Kepala Dinas PU Pemkab Morowali 10/11/11 28/11/11 16823587000002<strong>03</strong>3 04/10/2<strong>01</strong>1 445/1696/RSI/2<strong>01</strong>1 Dir. RS Indera Prov. Bali 10/11/11 28/11/11 16823586900042<strong>03</strong>4 04/10/2<strong>01</strong>1 B/6910/08/23/<strong>01</strong>/SET Kabag Umum Set Badan Sarana Pertahanan Kemhan 10/11/11 28/11/11 16823586700062<strong>03</strong>5 04/10/2<strong>01</strong>1 0<strong>01</strong>/LKI-Konversi/VI/2<strong>01</strong>1 Ketua LKI 10/11/11 05‐12‐2<strong>01</strong>1 1682360<strong>03</strong>00<strong>03</strong>Hal 97

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2<strong>03</strong>6 04/10/2<strong>01</strong>1 UM.002/II/3/UPP.LWI-2<strong>01</strong>1 Kapala Kantor Unit Penyelenggara Pelabuhan Laiwui 10/11/11 30/11/11 16823596800042<strong>03</strong>7 05/10/2<strong>01</strong>1 425/119/ADP Setda Pemkab Lombok Tengah 10/11/11 30/11/11 16823596300092<strong>03</strong>8 05/10/2<strong>01</strong>1 W3.TUN.4/720/UM.<strong>01</strong>.10/X/2<strong>01</strong>1Panitera/sekretaris Pengadilan Tata Usaha NegaraDenpasar2<strong>03</strong>9 05/10/2<strong>01</strong>1 S.804/BDK-1/2<strong>01</strong>1 Kabalai Diklat Kehutanan Samarinda 10/11/11 05‐12‐2<strong>01</strong>1 1682360220008Sertifikat masih berlaku2040 05/10/2<strong>01</strong>1 800/1537/414.052/2<strong>01</strong>1 Kadinas PU Kab. Tuban 10/11/11 05‐12‐2<strong>01</strong>1 16823608900<strong>03</strong>2041 05/10/2<strong>01</strong>1 12004/KP430/PSH/09.11 Kapus Veterinaria Farma 10/11/11 05‐12‐2<strong>01</strong>1 16823602300072042 06/10/2<strong>01</strong>1 B/10897/X/2<strong>01</strong>1/Datro Polda Metro Jaya 10/11/11 07‐12‐2<strong>01</strong>1 16823626100052043 06/10/2<strong>01</strong>1 S-158/WPJ.21/KP.05<strong>01</strong>/2<strong>01</strong>1 Kepala KPP Pratama Jakarta Klapa Gading 10/11/11 05/12/11 168236<strong>03</strong>000072044 06/10/2<strong>01</strong>1 050/186/Bapp-LH/2<strong>01</strong>12045 06/10/2<strong>01</strong>1 051/PGB-KPAD/112046 06/10/2<strong>01</strong>1 028/259/TUKepala Bappeda & Lingkungan Hidup PemkabKaimanaKa Kantor Pengelolaan Aset Daerah Kab. KutaiKartanegaraKepala Sekolah SPP-SPMA Negeri Prov. KalimantanBarat10/11/11 05‐12‐2<strong>01</strong>1 168236008000810/11/11 05‐12‐2<strong>01</strong>1 16823600900072047 06/10/2<strong>01</strong>1 074/4539/1.2 KA Balai Laboratorium Kesehatan Prov. Jawa Tengah 10/11/11 05‐12‐2<strong>01</strong>1 1682360280002Tidak ada sosialisasi perpres542048 06/10/2<strong>01</strong>1 B/376/DjMT/X/2<strong>01</strong>1 SekDitjend Badan Peradilan Militer dan TUN 10/11/11 05‐12‐2<strong>01</strong>1 168236<strong>01</strong>000<strong>03</strong>2049 06/10/2<strong>01</strong>1 600.<strong>01</strong>/183/TRBK/2<strong>01</strong>1 Kadinas PU Prov. Kalsel 10/11/11 06‐12‐2<strong>01</strong>1 16823616200052050 06/10/2<strong>01</strong>1 UM.002/12/X/UPP.BL-2<strong>01</strong>1Kakantor Unit Penyelenggara Pelabuhan Kelas III BuliDitjend Perhubungan Laut Kementerian Perhubungan2051 06/10/2<strong>01</strong>1 550/91/DISHUBKOMINFO/2<strong>01</strong>1Plt. Kadinas Perhubungan Kominfo Prov. MalukuUtara2052 06/10/2<strong>01</strong>1 W12-U3/1449/UM.09/IX/2<strong>01</strong>1 Panitera/Sekretaris Pengadilan Tinggi Tegal10/11/11 02‐12‐2<strong>01</strong>1 168235937000410/11/11 30/11/11 16823588000072053 06/10/2<strong>01</strong>1 660/0.1/418/KTG/IX/2<strong>01</strong>1 Plt. Kabadan Lingkungan Hidup Kab. Katingan 10/11/11 30/11/11 168236<strong>03</strong>400<strong>03</strong>Tidak ada fotocopysertifikat2054 06/10/2<strong>01</strong>1 094/<strong>027</strong>/BAPPEDA Bappeda Pemkab Sintang 11/11/11 19/12/11 16823642200042055 06/10/2<strong>01</strong>1 ..../SPT/2<strong>01</strong>1 Plt. Kadinas Sosial, Nakertrans Kab. Lingga 11/11/11 06‐12‐2<strong>01</strong>1 16823616200052056 06/10/2<strong>01</strong>1 800/395/DPU Kadinas PU Kab. Sanggau 10/11/11 02/12/11 16823593600052057 06/10/2<strong>01</strong>1 21.B/604/09/PU/2<strong>01</strong>1 Kadinas PU Kab. Bombana 10/11/11 30/11/11 16823598200042058 07/10/2<strong>01</strong>1 S.860/SMK Kehut-1/2<strong>01</strong>1 Kepala Sekolah SMK Kehutanan Samarinda 10/11/11 05‐12‐2<strong>01</strong>1 1682360750000Hal 98

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2059 07/10/2<strong>01</strong>1 <strong>027</strong>/2664/Ro.UHPKepala Biro Umum Humas dan Protokol Setda Prov.DIY10/11/11 07‐12‐2<strong>01</strong>1 16823618100002060 07/10/2<strong>01</strong>1 779/BL-PP/IX/050/2<strong>01</strong>1 Kepala Bappeda dan Litbang Kab. Indragiri Hulu 10/11/11 06‐12‐2<strong>01</strong>1 16823616000072061 07/10/2<strong>01</strong>1 .../DPU-S/IX/2<strong>01</strong>1 Kadinas PU Kab. Indragiri Hulu 09/11/11 07‐12‐2<strong>01</strong>1 16823626200042062 07/10/2<strong>01</strong>1 <strong>027</strong>/1816-BepBApp Kepala Bappeda Pemkot Bandung 11/11/11 30/11/11 16823598100052063 07/10/2<strong>01</strong>1 890/04/163 As. Ekobang Setda Pemkot Tomohon Sudah pernah dikonversi2064 07/10/2<strong>01</strong>1 W9-PR.<strong>01</strong>.02-464 Kakanwil Jateng Kemhukham 11/11/11 05‐12‐2<strong>01</strong>1 1682360<strong>01</strong>00052065 07/10/2<strong>01</strong>1 192/K/KR.VIII/IX/2<strong>01</strong>1 Kabag Umum BKN Kantor Regional VIII Banjarmasin 11/11/11 30/11/11 16823593100002066 07/10/2<strong>01</strong>1 050/121/DISTAKO/X/2<strong>01</strong>1 Dinas Tata Kota Pemkot Pangkalpinang 11/11/11 07‐12‐2<strong>01</strong>1 16823626000062067 07/10/2<strong>01</strong>1 800/40/UPTD-ULP/2<strong>01</strong>1Kasubbag TU UPTD Layanan PBJP Kota BANdaAceh11/11/11 30/11/11 16823593200092068 07/10/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/189/IX/2<strong>01</strong>1 Kepala Dinas PU Penprov. NTT 11/11/11 25/11/11 16823578100072069 07/10/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/188/IX/2<strong>01</strong>1 Kepala Dinas PU Penprov. NTT 14/11/11 25/11/11 16823578100072070 10/10/2<strong>01</strong>1 2802/BBPPI/Kp.525/X/2<strong>01</strong>1Plh. Kepala Balai Besar Pengembangan PenangkapanIkan Ditjend Perikanan Tangkap Kementerian KP10/11/11 05‐12‐2<strong>01</strong>1 16823607600092071 10/10/2<strong>01</strong>1 800/.../35.73.306/2<strong>01</strong>1 Kadinas Kesehatan Pemkot Malang Persyaratan tidaklengkap2072 10/10/2<strong>01</strong>1 129/SesKab-005.656382/X/2<strong>01</strong>1 Sekretaris Komisi Pemilihan Umum Kab. Kerinci2073 10/10/2<strong>01</strong>1 1836/J20/LL/2<strong>01</strong>1 Kabag Umum LPMP Pendidikan Prov. Sumbar 14/11/11 07‐12‐2<strong>01</strong>1 16823618000<strong>01</strong>Tidak ada sosialisasi perpres542074 10/10/2<strong>01</strong>1 714/H38.10/KP.02.252<strong>01</strong>1 Ketua LPM Universitas Negeri Surabaya 14/11/11 05‐12‐2<strong>01</strong>1 16823608000022075 10/10/2<strong>01</strong>1 8<strong>03</strong>/1690/2<strong>01</strong>1 Kepala BKD Pemkab Blora 14/11/11 06‐12‐2<strong>01</strong>1 16823617300<strong>01</strong>2076 10/10/2<strong>01</strong>1 700.04/1069.a/PP Kadinas Sos Prov. Jateng 10/11/11 02‐12‐2<strong>01</strong>1 16823599100022077 11/10/2<strong>01</strong>1 SM.3<strong>01</strong>/1/14/DJPD/2<strong>01</strong>1Setditjend Perhubungan Darat, KementerianPerhubungan11/11/11 05‐12‐2<strong>01</strong>1 16823611900<strong>03</strong>2078 11/10/2<strong>01</strong>1 600/2741 Setda Pemkab Kulonprogo 13/11/11 05‐12‐2<strong>01</strong>1 16823612000092079 11/10/2<strong>01</strong>1 - trisnan Saputra Sudah pernah dikonversi2080 11/10/2<strong>01</strong>1 005/4695 Setda Pemkab Jepara 14/11/11 05‐12‐2<strong>01</strong>1 16823611300092081 11/10/2<strong>01</strong>1 Kd.19.<strong>03</strong>/1/KU.00.2/553/2<strong>01</strong>1Kepala Kantor Kab. Lombok Timur KementerianAgama14/11/11 06‐12‐2<strong>01</strong>1 1682361250004Hal 99

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>Kepala Dinas Kelautan dan Perikanan Pemkab2082 11/10/2<strong>01</strong>1 810/59314/11/11 05‐12‐2<strong>01</strong>1 1682361140008Gunungkidul2083 11/10/2<strong>01</strong>1 - Abraham Z. Jaolath Sertifikat masih berlaku2084 11/10/2<strong>01</strong>1 602.1/925/DBMPSDA/IX/2<strong>01</strong>12085 11/10/2<strong>01</strong>1 B.1002/LATTAS-SES/X/2<strong>01</strong>1Kadinas Bina Marga dan Pengelolaan Sumber DayaAir Pemkab BekasiSetditjend Pembinaan Pelatihan dan ProduktivitasKemenakertrans14/11/11 07‐12‐2<strong>01</strong>1 168236202000214/11/11 07‐12‐2<strong>01</strong>1 16823620600082086 11/10/2<strong>01</strong>1 KP.<strong>01</strong>.<strong>01</strong>/BBWSSVIII/223.6Kabalai Besar Wilayah Sungai Sumatera VIII, DitjendSDA Kementerian PU11/11/11 06‐12‐2<strong>01</strong>1 16823611100<strong>01</strong>2087 12/10/2<strong>01</strong>1 028/1517 Sekda Pemkab Gunungkidul 07/11/11 30/11/11 16823595700082088 12/10/2<strong>01</strong>1 Sm.106/9/23.STIP2089 12/10/2<strong>01</strong>1 S-1123/PJ.04/2<strong>01</strong>1Kabag Keuangan dan Administrasi Umum STIPBPDSM PerhubunganDirektur Pemeriksaan dan Penagihan Ditjend PajakKementerian Keuangan14/11/11 05‐12‐2<strong>01</strong>1 168236090000914/11/11 05‐12‐2<strong>01</strong>1 16823610500002090 12/10/2<strong>01</strong>1 061/239 Kabiro Organisasi Setda Aceh 14/11/11 05‐12‐2<strong>01</strong>1 16823609300062091 12/10/2<strong>01</strong>1 Dj.II.5/Kp.088/2839/2<strong>01</strong>1Dir. Pemberdayaan Wakaf Ditjend Bimas IslamKementerian Agama14/11/11 05‐12‐2<strong>01</strong>1 16823609100082092 12/10/2<strong>01</strong>1 800/2268/PP Setda Pemkab Karangasem 14/11/11 05‐12‐2<strong>01</strong>1 16823609200072093 12/10/2<strong>01</strong>1 1023/RRI-PD/SEK/2<strong>01</strong>1 Kepala RRI Padang 14/11/11 05‐12‐2<strong>01</strong>1 16823609400052094 12/10/2<strong>01</strong>1 4949/C5.5/LL/2<strong>01</strong>1 Direktur P2TK Dikdas Kemendiknas 14/11/11 05‐12‐2<strong>01</strong>1 16823610400<strong>01</strong>2095 12/10/2<strong>01</strong>1 0<strong>03</strong>86/PL/10/2<strong>01</strong>1/ULP Kepala ULP Setjend Kementerian Luar Negeri 14/11/11 05‐12‐2<strong>01</strong>1 16823609800<strong>01</strong>2096 13/10/2<strong>01</strong>1 414.1/340/2<strong>01</strong>1 Camat Lebaksiu Sudah pernah dikonversi2097 13/10/2<strong>01</strong>1 800/2251/404.6.6/2<strong>01</strong>1 Kepala Badan Ketahanan Pangan Kab. Sidoarjo2098 13/10/2<strong>01</strong>1 890/PU-UPTJKSDM/121 Sek Dinas PU Prov. Riau2099 13/10/2<strong>01</strong>1 3549/-077Kadinas Kependudukan dan Catatan Sipil Prov. DKIJakarta04/04/12 PD02127442100 13/10/2<strong>01</strong>1 726/Ses KPU Prov-<strong>01</strong>2/09/X/2<strong>01</strong>1 Sekretaris KPU Prov. Jawa Tengah 14/11/11 05‐12‐2<strong>01</strong>1 1682360240006Tidak ada fotocopysertifikatTidak ada sosialisasi perpres54Tidak ada sosialisasi perpres5421<strong>01</strong> 13/10/2<strong>01</strong>1 130.04/142/Adpem/2<strong>01</strong>1 As. Ekobang Sekda Kab. Lombok Timur 14/11/11 05‐12‐2<strong>01</strong>1 16823602000002102 13/10/2<strong>01</strong>1 800/15578 Kadinas PU Prov. Papua 13/11/11 05‐12‐2<strong>01</strong>1 168236121000821<strong>03</strong> 13/10/2<strong>01</strong>1 632/UM-POLMAN BABEL/2<strong>01</strong>1Direktur Politeknik Manufaktur Negeri BangkaBelitung (dh. Politeknik Manufaktur Tanah07/11/11 22/11/11 1682357530004Hal 100

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2104 13/10/2<strong>01</strong>1 S-305/WPJ.05/BG.<strong>01</strong>/2<strong>01</strong>1Kabag Umum Kanwil DJP Jakarta Barat Ditjend PajakKementerian Keuangan10/11/11 05‐12‐2<strong>01</strong>1 16823599600072105 13/10/2<strong>01</strong>1 S.275/SMKHUT-1/2<strong>01</strong>1 Kepala Sekolah Kejuruan Kehutanan Pekanbaru Sertifikat masih berlaku2106 13/10/2<strong>01</strong>1 050/151 Setda Pemkot Pekalongan 15/11/11 06‐12‐2<strong>01</strong>1 16823612400052107 13/10/2<strong>01</strong>1 6<strong>01</strong>.1/78/ADT/2<strong>01</strong>1 Dinas PSDA Prov. Sumatera Utara 15/11/11 05‐12‐2<strong>01</strong>1 16823602100092108 13/10/2<strong>01</strong>1 <strong>027</strong>/633-TU/2<strong>01</strong>1 Dir. RSUD Kab. Indramayu 14/11/11 06‐12‐2<strong>01</strong>1 16823612600<strong>03</strong>2109 13/10/2<strong>01</strong>1 020/383Kepala Satuan Polisi Pamong Praja Dan WilayahHisbah Aceh14/11/11 06‐12‐2<strong>01</strong>1 16823614400092110 13/10/2<strong>01</strong>1 494/Sekr/X/2<strong>01</strong>1 Plh. Sekr. Daerah Kab. Minahasa Utara 11/11/11 07‐12‐2<strong>01</strong>1 16823618800<strong>03</strong>2111 14/10/2<strong>01</strong>1 800/2251/404.6.6/2<strong>01</strong>1 Kepala Badan Ketahanan Pangan Kab. Sidoarjo Sudah pernah dikonversi2112 14/10/2<strong>01</strong>1 41/UM.<strong>01</strong><strong>03</strong>/PJN-WIL.I/2<strong>01</strong>1Kepala Satuan Kerja Pelaksanaan Jalan NasionalWilayah I Prov. Papua Barat (Manokwari)Sudah pernah dikonversi2113 14/10/2<strong>01</strong>1 050/180/2<strong>01</strong>1 Kepala Bappeda Kab. Raja Ampat 14/11/11 30/11/11 168236<strong>03</strong>600<strong>01</strong>2114 14/10/2<strong>01</strong>1 <strong>01</strong>.06-W16/CK/X/283Kepala Bidang Cipta Karya Dinas PU Prov.Kalimantan Tengah14/11/11 30/11/11 16823602500052115 14/10/2<strong>01</strong>1 10.13.4/PSDKP 0.2.1/TU.210/X/2<strong>01</strong>1 Setditjend Pengawasan Sumber Daya KP 13/11/11 05‐12‐2<strong>01</strong>1 16823611000022116 17/10/2<strong>01</strong>1 800/20/IX/2<strong>01</strong>1 Pjs. Dirut PDAM Pemkab Tasikmalaya 14/11/11 30/11/11 168236<strong>01</strong>300002117 17/10/2<strong>01</strong>1 520/2353/Distanak/2<strong>01</strong>1 Plt. Sekda Pemkab Musi Banyuasin 14/11/11 30/11/11 168236<strong>01</strong>200<strong>01</strong>2118 17/10/2<strong>01</strong>1 Stk.05.1/KP.<strong>01</strong>.2/1558/2<strong>01</strong>1Ketua Sekolah Tnggi Agama Kristen Negeri (STAKN)Toraja2119 17/10/2<strong>01</strong>1 836/SesProv-<strong>01</strong>6/X/2<strong>01</strong>1 KPU Prov. Bali 14/11/1114/11/11 30/11/11 16823600700092120 17/10/2<strong>01</strong>1 467.1/2104 Kepala Dinas Sosial Pemerintah Aceh 14/11/11 05‐12‐2<strong>01</strong>1 1682359990004Tindak Lanjut S.Ket<strong>No</strong>.2443.105/D.III.3/06/2<strong>01</strong>12121 18/10/2<strong>01</strong>1 <strong>027</strong>/581-DPPKAKadinas Pendapatan Pengelolaan Keuangan dan AsetKab. Garut10/11/11 05‐12‐2<strong>01</strong>1 16823600200042122 18/10/2<strong>01</strong>1 002/1291/DISDIK/1.1/2<strong>01</strong>1 Kadinas Pendidikan Prov. Kepulauan Riau Sertifikat masih berlaku2123 18/10/2<strong>01</strong>1 420/340Kepala Badan Pemerintahan Kampung danPemberdayaan Masyarakat Kab. Merauke10/11/11 05‐12‐2<strong>01</strong>1 16823599400092124 18/10/2<strong>01</strong>1 <strong>027</strong>/3711/Perl/2<strong>01</strong>1 Setda Kab. Buleleng 14/11/11 07‐12‐2<strong>01</strong>1 1682361830008Hal 1<strong>01</strong>

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2125 18/10/2<strong>01</strong>1 4660/PL.210/E.1/10/2<strong>01</strong>1 Sekretaris Ditjend Perkebunan Kementerian Pertanian 14/11/11 07‐12‐2<strong>01</strong>1 16823618400072126 18/10/2<strong>01</strong>1 UM.002/608/X/2<strong>01</strong>1Kepala Bandar Udara Domine Eduard Osok SorongDitjend Perhubungan Udara Kementerian Perhubungan14/11/11 07‐12‐2<strong>01</strong>1 16823617900052127 18/10/2<strong>01</strong>1 - - 14/11/11Tidak ada alamatpengiriman Sertifikat a.n.Melodi2128 18/10/2<strong>01</strong>1 15/IAPI/SP/X/2<strong>01</strong>1 Wasesjend DPP IAPI 14/11/11 07‐12‐2<strong>01</strong>12129 19/10/2<strong>01</strong>1 550/116/DISHUBKOMINFO/2<strong>01</strong>12130 19/10/2<strong>01</strong>1 144/SET/X/2<strong>01</strong>1Plt. Kepala Dinas Perhubungan Komunikasi danInformatika Prov. Maluku UtaraPlt. Sekretaris Komisi Pemilihan Umum (KPU) Kab.Nduga14/11/11 05‐12‐2<strong>01</strong>1 1682361<strong>01</strong>000414/11/11Tidak ada alamatpengiriman2131 19/10/2<strong>01</strong>1 004/LPPN/X/2<strong>01</strong>1Direktur Program Lembaga PengembanganPengetahuan Nusantara (LPPN)16/11/11 06‐12‐2<strong>01</strong>1 16823617400002132 19/10/2<strong>01</strong>1 S.449/VIII/P3PIK-1/2<strong>01</strong>1Kepala Pusat Litbang Perubahan Iklim dan KebijakanBalitbang Kehutanan Kementerian Kehutanan16/11/11 30/11/11 16823595800072133 19/10/2<strong>01</strong>1 Un.<strong>01</strong>/R/KS.<strong>01</strong>.6/1658/2<strong>01</strong>1 Rektor UIN Syarif Hidayatullah Jakarta2134 19/10/2<strong>01</strong>1 500/508/430.11.10/2<strong>01</strong>1 Kepala Kantor Ketahanan Pangan Kab. Bondowoso 16/11/11 30/11/11 16823595900062135 20/10/2<strong>01</strong>1 520/09.11/SEK/X/2<strong>01</strong>1Kepala Dinas Pertanian dan Peternakan Pemkab ParigiMountong10/11/11 02‐12‐2<strong>01</strong>1 16823593400072136 20/10/2<strong>01</strong>1 PR.8<strong>01</strong>/12/<strong>01</strong>/OP.MKS.11Kepala Kantor Otoritas Pelabuhan Wilayah IVMakassar10/11/11 02‐12‐2<strong>01</strong>1 16823600400022137 20/10/2<strong>01</strong>1 785/sesprov.<strong>01</strong>8/X/2<strong>01</strong>1Plt. Sekretaris Komisi Pemilihan Umum (KPU) Prov.NTT09/11/11 14/11/11 16823564100002138 20/10/2<strong>01</strong>1 UK.112/06/06/UPP.MU-11Kepala Kantor Unir Penyelenggara Pelabuhan Kelas IIIMamuju13/11/11 30/11/11 168236<strong>01</strong>600072139 20/10/2<strong>01</strong>1 PH.321/2/1/AD.PTK-2<strong>01</strong>1 Kepala Kantor Administrator Pelabuhan Pontianak 13/11/11 30/11/11 168236<strong>03</strong>100062140 20/10/2<strong>01</strong>1 UM.007/2/8-BLTL-2<strong>01</strong>1 Kapuslitbang Perhubungan LautTidak ada sosialisasi perpres54Tidak ada sosialisasi perpres542141 20/10/2<strong>01</strong>1 800/1337/BKD-1/X/2<strong>01</strong>1 Kepala BKD Kab. Katingan Sertifikat masih berlaku2142 21/10/2<strong>01</strong>1 W5-U/50/KS.00/X/2<strong>01</strong>1 Panitera/Sekretaris Pengadilan Tinggi Jambi 13/11/11 30/11/11 168236<strong>01</strong>400092143 21/10/2<strong>01</strong>1 S-182/WPJ.23/KP.<strong>01</strong>/2<strong>01</strong>1Kepala KPP Pratama Sleman Kanwil DIY Ditjen PajakKementerian Keuangan13/11/11 30/11/11 16823594200062144 21/10/2<strong>01</strong>1 245/srt/Ro.3/X/2<strong>01</strong>1Kepala Biro Keuangan Kementerian Kebudayaan danPariwisataTidak ada fotocopysertifikatHal 102

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2145 21/10/2<strong>01</strong>1 PL.102/1/10/CT-2<strong>01</strong>1Kepala Bandar Udara Radin Inten II Lampung, DitjenPerhubungan Udara Kementerian PerhubunganTidak ada sosialisasi perpres542146 24/10/2<strong>01</strong>1 780/069/DPU/JWY/2<strong>01</strong>1 Kepala Dinas PU Kab. Jaya Wijaya 13/11/11 30/11/11 16823594300052147 24/10/2<strong>01</strong>1 20/DST/PLP/X/2<strong>01</strong>1 Corporate Manager Diponegoro Smart Solution 11/11/11 07‐12‐2<strong>01</strong>1 16823621500062148 24/10/2<strong>01</strong>1 1734/FTP-UGM/LK/2<strong>01</strong>1 Kepala Kantor Administrasi FTP Univ. Gajahmada 13/11/11 06‐12‐2<strong>01</strong>1 16823612200072149 24/10/2<strong>01</strong>1 055/34<strong>03</strong>/416-206/2<strong>01</strong>1 Plt. Setda Pemkab Mojokerto 13/11/11 30/11/11 16823594400042150 24/10/2<strong>01</strong>1 800/364/BAKIASDA/2<strong>01</strong>1Kepala Badan Komunikasi, Informatika Arsip danSandi Daerah Kab. Kotabaru13/11/11 07‐12‐2<strong>01</strong>1 16823621700042151 24/10/2<strong>01</strong>1 500/2242/IV/2<strong>01</strong>1 Plt. Setda Pemkab. Musi Banyuasin 13/11/11 05‐12‐2<strong>01</strong>1 16823607800072152 24/10/2<strong>01</strong>1 B/1850/X/2<strong>01</strong>1/Lemdikpol Karo Renmin Lembaga Pendidikan POLRI 13/11/11 30/11/11 16823595100042153 24/10/2<strong>01</strong>1 18006/TU.210/F2.E/10/2<strong>01</strong>1Kepala Balai Besar Pembibitan Ternak Unggul SapiPerah Baturraden Ditjen Peternakan dan KesehatanHewan Kementerian Pertanian13/11/11Tidak ada alamatpengiriman Sertifikat2154 25/10/2<strong>01</strong>1 B/2699/X/2<strong>01</strong>1 Direktur Kesehatan AD 11/11/11 05‐12‐2<strong>01</strong>1 16823599800052155 25/10/2<strong>01</strong>1 028/2485/Kes/IV/2<strong>01</strong>1 Kadinas Kesehatan Prov. Sumsel 13/11/11 05‐12‐2<strong>01</strong>1 16823607400<strong>01</strong>2156 25/10/2<strong>01</strong>1 3190/PL00<strong>01</strong>/BU/X/2<strong>01</strong>12157 25/10/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>01</strong>-Am/84/2<strong>01</strong>12158 25/10/2<strong>01</strong>1 411/654/ADPEMB/2<strong>01</strong>12159 26/10/2<strong>01</strong>1 SM.005/1/1/DNG.PLG-2<strong>01</strong>1Plh. Kabiro Umum Badan Pengawas Tenaga Nuklir(BAPETEN)Kepala Balai Besar Wilayah Sungai Brantas DitjenSDA Kementerian PUKabiro Administrasi Pembangunan Setda Prov.Kalimantan TengahKepala Distrik Navigasi Kelas I Palembang DitjenPerhubungan Laut Kementerian Perhubungan13/11/11 05‐12‐2<strong>01</strong>1 168236077000813/11/11 15/11/11 16823607400<strong>01</strong>13/11/11 30/11/11 168235908000211/11/11 07‐12‐2<strong>01</strong>1 16823618900022160 26/10/2<strong>01</strong>1 050/082/007/2<strong>01</strong>1 Setda Kab. Bima Persyaratan tidak lengkap2161 26/10/2<strong>01</strong>1 W4.BJ.PL.02.<strong>03</strong>-5322162 26/10/2<strong>01</strong>1 Kp.06.02Bj/786Kepala Kantor Imigrasi Selatpanjang Kanwil RiauKementerian Hukum dan HAMPlh. Kabalai Besar Pelaksanaan Jalan Nasional XDitjend Bina Marga Kementerian PU13/11/11 05‐12‐2<strong>01</strong>1 16823610700082163 26/10/2<strong>01</strong>1 <strong>027</strong>/65Kepala Bidang Bina Teknik dan Jasa Konstruksi DinasPU Pemprov. Maluku10/11/11 05‐12‐2<strong>01</strong>1 16823599500082164 26/10/2<strong>01</strong>1 S-3616/PJ.<strong>01</strong>/UP.51/2<strong>01</strong>1 Setditjend Kementerian Keuangan 16/11/11 07‐12‐2<strong>01</strong>1 16823624100<strong>01</strong>Persyaratan tidak lengkapHal 1<strong>03</strong>

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2165 27/10/2<strong>01</strong>1 - Muh. Arham Marasobu Sertifikat masih berlaku2166 27/10/2<strong>01</strong>1 600/3<strong>01</strong>2 Setda Pemkab Kulonprogo 13/11/11 06‐12‐2<strong>01</strong>1 16823612300062167 27/10/2<strong>01</strong>1 Pemb.005/2.714/X/2<strong>01</strong>1 Kabag Pembangunan setda Kab. Sumba Timur 13/11/11 07‐12‐2<strong>01</strong>1 16823619100072168 27/10/2<strong>01</strong>1 800/979 Kepala Dishubkominfo Pemkab Gunungkidul 13/11/11 07‐12‐2<strong>01</strong>1 16823619300052169 27/10/2<strong>01</strong>1 B.2004/BKKPN/X/2<strong>01</strong>12170 27/10/2<strong>01</strong>1 PL.00.<strong>01</strong>/7/1233/2<strong>01</strong>1Kepala Balai Kawasan Konservasi Perairan Nasional(BKKPN) Kupang - Ditjend Kelautan, Pesisir danPulau-pulau kecil, Kem.KPKepala Balai Besar Pelatihan Kesehatan JakartaBPPSDM Kesehatan Kementerian Kesehatan13/11/11 02‐12‐2<strong>01</strong>1 168235979000<strong>01</strong>3/11/11 07‐12‐2<strong>01</strong>1 16823619400042171 27/10/2<strong>01</strong>1 525/2177/TU-2Plt. Kepala Dinas Perkebunan Pemprov. KalimantanSelatan2172 27/10/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/II.1/677/2<strong>01</strong>1 Direktur Utama RSUP Fatmawati2173 27/10/2<strong>01</strong>1 055/623/416-318/2<strong>01</strong>1 Camat Mojoanyar 13/11/11 07‐12‐2<strong>01</strong>1 1682362160005Sudah pernah dikonversiTidak ada fotocopysertifikat2174 27/10/2<strong>01</strong>1 Kd.13.09/1/KS.02/2363/2<strong>01</strong>1 Kepala Kantor Kementerian Agama Kab. Jember Sudah pernah dikonversi2175 28/10/2<strong>01</strong>1 550/UN19.2/PL/2<strong>01</strong>1 Ketua Lemlit Universitas Riau 28/11/11 05‐12‐2<strong>01</strong>1 16823608100<strong>01</strong>2176 28/10/2<strong>01</strong>1 <strong>027</strong>/1107/426.307/2<strong>01</strong>1 Setda Pemkab Probolinggo 28/11/11 05‐12‐2<strong>01</strong>1 16823611600062177 28/10/2<strong>01</strong>1 206/9.2-100.9/X/2<strong>01</strong>1 Kapusdiklat Badan Pertanahan Nasional (BPN) 28/11/11 05‐12‐2<strong>01</strong>1 16823610800072178 28/10/2<strong>01</strong>1 243/S/KP/X/2<strong>01</strong>12179 28/10/2<strong>01</strong>1 SP-1512/WPB.<strong>01</strong>/KP.<strong>01</strong>10/2<strong>01</strong>12180 31/10/2<strong>01</strong>1 PD.02.<strong>01</strong>-Ao.3.2/192181 31/10/2<strong>01</strong>1 SM.3<strong>01</strong>/02/140/UPP.JPT-11Kabag Perlengkapan Set Kementerian Riset danTeknologi (Kemenristek)Kepala Kantor Pelayanan Perbendaharaan NegaraBanda Aceh Ditjen Perbendaharaan Kanwil AcehKementerian KeuanganKabid Pelaksana Jaringan Sumber Air BBWS PemaliJuana Ditjen SDA Kementerian PUKepala Kantor Unit Penyelenggara Pelabuhan Kelas IIIJeneponto Ditjend Perhubungan Laut KementerianPerhubungan14/11/11 02‐12‐2<strong>01</strong>1 168235993000<strong>01</strong>6/11/11 02‐12‐2<strong>01</strong>1 168235935000628/11/11 05‐12‐2<strong>01</strong>1 1682361180004Sama dengan <strong>No</strong>. Surat199/BU/VII/2<strong>01</strong>1Tidak ada sosialisasi perpres542182 31/10/2<strong>01</strong>1 Kw.32.1/HM.<strong>01</strong>/3729/2<strong>01</strong>1Kepala Kanwil Prov. Kepulauan Riau KementerianAgama29/11/11 06‐12‐2<strong>01</strong>1 16823614000<strong>03</strong>2183 31/10/2<strong>01</strong>1 DL.10/108/976/X/BTO/2<strong>01</strong>1Kakantor Bandar Udara Budiarto Ditjend PerhubUdaraKementerian Perhubungan29/11/11 07‐12‐2<strong>01</strong>1 16823624000022184 31/10/2<strong>01</strong>1 B/6504/IX/2<strong>01</strong>1/Rosarpras Karosarpras Polda Jatim Sertifikat masih berlakuHal 104

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2185 31/10/2<strong>01</strong>1 PD.06.<strong>03</strong>/BWS.KAL.II/676Kasubbag TU BWS Kalimantan II Ditjend SDAKementerian PU29/11/11 07‐12‐2<strong>01</strong>1 16823626700092186 31/10/2<strong>01</strong>1 Kd.19.07/1-a/Kp.02.3/1754/2<strong>01</strong>1 Kepala Kantor Kementerian Agama Kota Mataran 28/11/11 05‐12‐2<strong>01</strong>1 16823610600092187 31/10/2<strong>01</strong>1 893/6778Kepala Dinas Kehutanan dan Perkebunan Pemprov.DIY23/11/11 05‐12‐2<strong>01</strong>1 16823610000052188 31/10/2<strong>01</strong>1 530/70.a/IND/X/11Kadinas Perindustrian, Perdagangan dan PenanamanModal Pemkab Seram Bagian Barat28/11/11 05‐12‐2<strong>01</strong>1 16823611700052189 31/10/2<strong>01</strong>1 20/IAPI/SP/X/2<strong>01</strong>1 Wasesjend DPP IAPI 28/11/11 06‐12‐2<strong>01</strong>1 16823610000052190 31/10/2<strong>01</strong>1 043/90/BDA/2<strong>01</strong>1Direktur Perguruan Tinggi Kedinasan AkademiMinyak dan Gas Bumi - STEM Badiklat ESDMKementerian ESDM2191 31/10/2<strong>01</strong>1 PD.<strong>03</strong>.08/BL.IX/47Kepala Balai Pelaksanaan Jalan Nasional IX DitjendBina Marga Kementerian PU29/11/11 07‐12‐2<strong>01</strong>1 16823621000<strong>01</strong>2192 31/10/2<strong>01</strong>1 050/3782 Asisten Adm Umum Setda Pemkab Tegal 16/11/11 02‐12‐2<strong>01</strong>1 16823598500<strong>01</strong>Sertifikat masih berlaku2193 <strong>01</strong>/11/2<strong>01</strong>1 Kw.06.1/5/HM.<strong>01</strong>/.../2<strong>01</strong>1 Kepala Kanwil Prov. Sumsel Kementerian Agama 28/11/11 07‐12‐2<strong>01</strong>1 16823619200062194 <strong>01</strong>/11/2<strong>01</strong>1 - Sekretaris LPPM Univ. Malikussaleh Kemdiknas 29/11/11 06‐12‐2<strong>01</strong>1 16823615500052195 <strong>01</strong>/11/2<strong>01</strong>1 1773/FTP-UGM/LK/2<strong>01</strong>12196 <strong>01</strong>/11/2<strong>01</strong>1 UM.0<strong>03</strong>/2/19/DNG.Smr-11Kepala Kantor Administrasi Fakultas TeknologiPertanian Univ. Gadjah MadaKepala Distrik Navigasi Kelas I Samarinda DitjendPerhubungan Laut Kementerian Perhubungan24/11/11 07‐12‐2<strong>01</strong>1 168236209000529/11/11 06‐12‐2<strong>01</strong>1 16823615700<strong>03</strong>2197 <strong>01</strong>/11/2<strong>01</strong>1 00423/PL/10/2<strong>01</strong>1/ULP Kepala ULP Setjend Kementerian Luar Negeri 28/11/11 06‐12‐2<strong>01</strong>1 16823614100022198 <strong>01</strong>/11/2<strong>01</strong>1 S.479/Ren-1/2<strong>01</strong>1 Kabiro Perencanaan Setjend Kementerian Kehutanan 23/11/11 07‐12‐2<strong>01</strong>1 16823616400<strong>03</strong>2199 02/11/2<strong>01</strong>1 800/1635/RSUD Kabag TU RSUD Pemkab Klungkung 23/11/11 05‐12‐2<strong>01</strong>1 16823600000062200 02/11/2<strong>01</strong>1 56/IV/Ro.PERKAP/2<strong>01</strong>122<strong>01</strong> 02/11/2<strong>01</strong>1 B.8925/BBPPK/X/2<strong>01</strong>1 Kepala BBPPK LembangKabiro Perlengkapan dan Pengelolaan Aset Setd4ov.Sumatera Utara23/11/11 07‐12‐2<strong>01</strong>1 1682361780006Sama dengan <strong>No</strong>. Surat800/1426/RSUDSertifikat masih berlaku danTidak ada sosialisasi perpres542202 02/11/2<strong>01</strong>1 D.4<strong>03</strong>/KP.107/BPPP-11 Kepala Balai Diklat Penerbangan Palembang 23/11/11 07‐12‐2<strong>01</strong>1 168236177000722<strong>03</strong> 02/11/2<strong>01</strong>1 5555/DPB/TU-210.D3/X/2<strong>01</strong>1Plh. Direktur Produksi Ditjend Perikanan BudidayaKementerian KPTidak ada sosialisasi perpres542204 02/11/2<strong>01</strong>1 050/.../007/2<strong>01</strong>1 Setda Pemkab Bima 29/11/11 07‐12‐2<strong>01</strong>1 16823621300082205 02/11/2<strong>01</strong>1 - Setda Kota Salatiga 23/11/11 07‐12‐2<strong>01</strong>1 1682362<strong>01</strong>00<strong>03</strong>Sama dengan <strong>No</strong>. Surat<strong>027</strong>/766Hal 105

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2206 <strong>03</strong>/11/2<strong>01</strong>1 050/472/BappemdalKepala Bappeda dan Penanaman Modal Kab. TanjungJabung BaratSertifikat masih berlaku2207 <strong>03</strong>/11/2<strong>01</strong>1 1<strong>03</strong>/ADM.PEM/X/2<strong>01</strong>1 Setda Kab Morowali 28/11/11 05‐12‐2<strong>01</strong>1 16823608300092208 <strong>03</strong>/11/2<strong>01</strong>1 833/461 Kadinas PU Prov. Sulawesi Tenggara 28/11/11 05‐12‐2<strong>01</strong>1 16823611500072209 <strong>03</strong>/11/2<strong>01</strong>1 S-2048/WPJ.21/2<strong>01</strong>1Kepala Kanwil DJP Jakarta Utara Ditjend PajakKementerian Keuangan23/11/11 07‐12‐2<strong>01</strong>1 16823619000082210 04/11/2<strong>01</strong>1 800/926/BKD/KK/2<strong>01</strong>1 Kepala BKD Bintuhan 05‐12‐2<strong>01</strong>1 16823608200002211 04/11/2<strong>01</strong>1 <strong>027</strong>/3838/404.2/2<strong>01</strong>1 SetDPRD Kab. Sidoarjo 23/11/11 07‐12‐2<strong>01</strong>1 16823618700042212 04/11/2<strong>01</strong>1 02/SNVT.PJSA.BBWS-PJPS/11/2<strong>01</strong>1 Muh. Arham Marasobu Sertifikat masih berlaku2213 04/11/2<strong>01</strong>1 B-326/Kemsetneg/Setmen/Um/11/2<strong>01</strong>12214 04/11/2<strong>01</strong>1 B-48/Kemsetneg/D-1/DDKI/DK.<strong>03</strong>.00/11/2<strong>01</strong>1Kabiro Umum Kemsetneg 23/11/11 07‐12‐2<strong>01</strong>1 1682361850006Asisten Deputi Dukungan Data Kebijakan danInformatika Kemsetneg23/11/11 07‐12‐2<strong>01</strong>1 16823617500092215 04/11/2<strong>01</strong>1 S-599/SJ.7/2<strong>01</strong>1 Kabiro Perlengkapan Setjend Kementerian Keuangan 16/11/11 06‐12‐2<strong>01</strong>1 16823611200002216 04/11/2<strong>01</strong>1 PL.0<strong>03</strong>/1/88-SAR AMB Kepala Kantor SAR XX Ambon 23/11/11 07‐12‐2<strong>01</strong>1 16823617100<strong>03</strong>2217 04/11/2<strong>01</strong>1 8688/-884.382218 04/11/2<strong>01</strong>1 800/654/KeuKepala Sudin Kesehatan Kota Administrasi JakartaTimurSekretaris Sekretariat Dewan Pengurus KORPRIPemprov. Jabar23/11/11 07‐12‐2<strong>01</strong>1 168236170000423/11/11 07‐12‐2<strong>01</strong>1 16823617200022219 04/11/2<strong>01</strong>1 <strong>027</strong>/4263/Adm.Pemb Setda Pemkab Badung 23/11/11 07‐12‐2<strong>01</strong>1 16823616700002220 04/11/2<strong>01</strong>1 893/3342/Hubkominfo Kepala Dinas Perhubungan Kominfo Kab. Badung 23/11/11 07‐12‐2<strong>01</strong>1' 16823616800092221 07/11/2<strong>01</strong>1 <strong>027</strong>/680.TU Direktur RSUD Kab. Indramayu 23/11/11 07‐12‐2<strong>01</strong>1 16823616500022222 07/11/2<strong>01</strong>1 594-3/002525/VI Wakil Walikota Palembang 14/11/11 30/11/11 16823590500052223 07/11/2<strong>01</strong>1 620/186/Dis.PU/BLG/2<strong>01</strong>1 Kepala Dinas PU Pemkab Balangan 23/11/11 07‐12‐2<strong>01</strong>1 16823617600082224 07/11/2<strong>01</strong>1 893.3/177Kabalai Pemberdayaan dan Pengawasan JasaKonstruksi Dinas Cipta Karya dan Tata Ruang Prov.Jateng23/11/11 07‐12‐2<strong>01</strong>1 16823616900082225 08/11/2<strong>01</strong>1 0627/1268/UMUM2226 08/11/2<strong>01</strong>1 526/343Plh. Kadinas Perhubungan , Informatika danKomunikasi kota cirebonKepala Kantor Penyuluhan dan Ketahanan PanganPemkab Kepulauan Yapen16/11/11 05‐12‐2<strong>01</strong>1 1682359970006Tidak ada sosialisasi perpres54Hal 106

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2227 08/11/2<strong>01</strong>1 050/230 Sekretaris Dinas PU Pemkab Manokwari 16/11/11 05‐12‐2<strong>01</strong>1 16823600600002228 08/11/2<strong>01</strong>1 PD.<strong>03</strong>.08/BL.IX/48Kepala Balai Pelaksanaan Jalan Nasional IX DitjendBina Marga Kementerian PU2229 08/11/2<strong>01</strong>1 600/591/2<strong>01</strong>1 Kadinas PU Kab. Kepl Aru2230 08/11/2<strong>01</strong>1 27/P2EM/X/2<strong>01</strong>1Ketua Pusat Penelitian Ekonomi dan Manajemen(P2EM) Univ. Tanjungpura16/11/11 02‐12‐2<strong>01</strong>1 168236<strong>01</strong>7000623/11/11 07‐12‐2<strong>01</strong>1 1682362140007Sertifikat masih berlaku danTidak ada sosialisasi perpres542231 08/11/2<strong>01</strong>1 050/1868/DISHUBKOMINFO/2<strong>01</strong>1 Kadinas Hubkominfo Prov. Sumatera Barat 16/11/11 02‐12‐2<strong>01</strong>1 168236<strong>01</strong>800052232 08/11/2<strong>01</strong>1 <strong>027</strong>/51/437.33/2<strong>01</strong>1 Kabag Perlengkapan Setda Pemkab Gresik 16/11/11 02‐12‐2<strong>01</strong>1 16823593800<strong>03</strong>2233 08/11/2<strong>01</strong>1 175/236/008/UMPERKEP/IX/2<strong>01</strong>1 Set. DPRD Pemkab Kutai Timur 16/11/11 30/11/11 168236<strong>01</strong>500082234 08/11/2<strong>01</strong>1 800/0<strong>01</strong>489 Kepala BKD Kab. Tegal Sudah pernah dikonversi2235 09/11/2<strong>01</strong>1 Um.<strong>01</strong>.<strong>03</strong>-BS/663.1 Setditjend Bina Marga Kementerian PU 17/11/11 28/11/11 16823589400002236 09/11/2<strong>01</strong>1 050/106.2/Umum Setda Pemkot Bontang 17/11/11 02‐12‐2<strong>01</strong>1 16823598600002237 09/11/2<strong>01</strong>1 A-1/1990/PSAA-TB/XI/2<strong>01</strong>1Kepala Panti Sosial Asuhan Anak "Tunas Bangsa"Ditjend Rehabilitasi Sosial Kementerian Sosial17/11/11 05‐12‐2<strong>01</strong>1 168236<strong>03</strong>200052238 09/11/2<strong>01</strong>1 221/UN33.9/PM/2<strong>01</strong>1 Sekretaris LPM Univ. Negeri Medan 28/11/11 05‐12‐2<strong>01</strong>1 16823610900062239 09/11/2<strong>01</strong>1 PD.06.<strong>03</strong>/BWS.KAL.II/806Kasubag TU BWS Kalimantan II Ditjend SDAKementerian PU28/11/11 28/12/11 17610470400062240 10/11/2<strong>01</strong>1 3112/LSN/SU/PL.202/11/2<strong>01</strong>1 Sestama Lembaga Sandi Negara 17/11/11 05‐12‐2<strong>01</strong>1 168236<strong>03</strong>300042241 10/11/2<strong>01</strong>1 09106/TU.210/F.1/11/2<strong>01</strong>1Setditjend Peternakan dan Kesehatan HewanKementerian Pertanian28/11/11 07‐12‐2<strong>01</strong>1 16823626500<strong>01</strong>2242 10/11/2<strong>01</strong>1 893.3/807.29/XI/2<strong>01</strong>1 Kepala BKD Kab. Karanganyar 30/11/11 07‐12‐2<strong>01</strong>1 16823620500092243 10/11/2<strong>01</strong>1 Bapp.650/693/2<strong>01</strong>1 Kepala BAPPEDA Pemkab Alor 28/11/11 07‐12‐2<strong>01</strong>1 16823623900062244 10/11/2<strong>01</strong>1 DKP.582/VII/2<strong>01</strong>1 Kepala Dinas Kelautan dan Perikanan Kab. Alor 28/11/11 07‐12‐2<strong>01</strong>1 16823623700082245 10/11/2<strong>01</strong>1 08/IAPI/SP/XI/2<strong>01</strong>1 Wasesjend DPP IAPI 30/11/11 07‐12‐2<strong>01</strong>12246 10/11/2<strong>01</strong>1 07/IAPI/SP/XI/2<strong>01</strong>1 Wasesjend DPP IAPI 30/11/11 07‐12‐2<strong>01</strong>1Hal 107

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2247 10/11/2<strong>01</strong>1 050/200/APP/2<strong>01</strong>12248 10/11/2<strong>01</strong>1 5839/H23.9/KS.00.<strong>01</strong>/2<strong>01</strong>12249 11/11/2<strong>01</strong>1 S.185/S-PSIK/11-2<strong>01</strong>1Kabag Adm. PErekonomian PEmbangunan SetdaDompuKetua LPPM Univ.Jenderal Soedirman (Unsoed)KemdiknasPelaksana Program Pusat Studi Investasi dan Keuangan(PSIK)28/11/11 07‐12‐2<strong>01</strong>1 168236235000028/11/11 07‐12‐2<strong>01</strong>1 168236233000230/11/11 07‐12‐2<strong>01</strong>1 16823619800002250 11/11/2<strong>01</strong>1 107.A/800/DPU/VII/2<strong>01</strong>1 Sekretaris Dinas PU Pemkab Kutai Kartanegara 30/11/11 06‐12‐2<strong>01</strong>1 16823613200042251 11/11/2<strong>01</strong>1 B/1211/XI/2<strong>01</strong>1/Korlantas Waka Korps Lalu Lintas POLRI 28/11/11 06‐12‐2<strong>01</strong>1 16823614200<strong>01</strong>2252 11/11/2<strong>01</strong>1 893/6980Kepala Dinas Kehutanan dan Perkebunan (Dishutbun)Pemprov. DIY23/11/11 05‐12‐2<strong>01</strong>1 1682361000005Sama dengan <strong>No</strong>. Surat893/67782253 11/11/2<strong>01</strong>1 B/2963/IX/2<strong>01</strong>1 Kepala Staf Kodam III/Siliwangi tidak ada fotocopy sertifikat2254 11/11/2<strong>01</strong>1 B.1772/P2MKT-SES/XI/2<strong>01</strong>1Sekretaris Ditjen Pembinaan PengembanganMasyarakat dan Kawasan Transmigrasi (P2MKT)Kemenakertrans30/11/11 07‐12‐2<strong>01</strong>1 16823620400002255 11/11/2<strong>01</strong>1 9<strong>03</strong>/1858/2<strong>01</strong>1 Kadinas Hubkominfo dan Telematika Pemerintah Aceh Persyaratan tidak lengkap2256 14/11/2<strong>01</strong>1 800/1397-UMPEG2257 14/11/2<strong>01</strong>1 S.5446/IV-K.10/2<strong>01</strong>1Kepala Dinas Pertanian Tanaman Pangan danHortikultura Pemprov. Kalimantan SelatanKabalai KSDA DKI Jakarta Ditjend PerlindunganHutan dan Konservasi Alam Kementerian Kehutanan29/11/11 06‐12‐2<strong>01</strong>1 168236146000707/12/11 12/12/11 16823629000072258 14/11/2<strong>01</strong>1 650/217/D.1/X/2<strong>01</strong>1 Kadinas PU Kota MetroTidak ada sosialisasi perpres542259 14/11/2<strong>01</strong>1 690/323/PDAM-SDM/2<strong>01</strong>1 Dirut PDAM Pemkot Banjarmasin 07/12/11 12/12/11 16823629100062260 14/11/2<strong>01</strong>1 521.1/1886/Sek.1/XI/2<strong>01</strong>1Kepala Dinas Pertanian Tanaman Pangan Kab. KutaiKartanegara30/11/11 07‐12‐2<strong>01</strong>1 16823619700<strong>01</strong>2261 14/11/2<strong>01</strong>1 800/284/35.09.25/2<strong>01</strong>1 Camat Jelbuk Pemkab Jember 30/11/11 07‐12‐2<strong>01</strong>1 1682362<strong>03</strong>00<strong>01</strong>2262 14/11/2<strong>01</strong>1 - Arkom Persyaratan tidak lengkap2263 14/11/2<strong>01</strong>1 11.5/BBAPT/TU.210/XI/2<strong>01</strong>1Kepala Balai Budidaya Air Payau Takalar DitjenPerikanan Budidaya Kementerian KP29/11/11 06‐12‐2<strong>01</strong>1 16823612800<strong>01</strong>2264 15/11/2<strong>01</strong>1 9<strong>03</strong>/BKIPM.I/X/2<strong>01</strong>1Kabag Keuangan dan Umum Badan Karantina Ikan,Pengendalian Mutu dan Keamanan Hasil PerikananKementerian KPTidak ada sosialisasi perpres542265 15/11/2<strong>01</strong>1 1029/040/GM/2<strong>01</strong>1Manajer Bidang Pembangkitan PT. PLN WilayahSulsel, Sultra dan SumbarTidak ada fotocopysertifikatHal 108

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2266 15/11/2<strong>01</strong>1 S.1254/Set-2/2<strong>01</strong>1Plt. Setditjen Bina Usaha Kehutanan KementerianKehutananTidak ada sosialisasi perpres542267 15/11/2<strong>01</strong>1 PU.760/3800/X/2<strong>01</strong>1 Kadinas PU Kab. Manggarai Barat Persyaratan tidak lengkap2268 15/11/2<strong>01</strong>1 - Cahyo Prayitno, Lamhot Sipayung, Riya Suriansyah 29/11/11 07‐12‐2<strong>01</strong>1 16823620000042269 15/11/2<strong>01</strong>1 1689/1.195.211/2<strong>01</strong>12270 15/11/2<strong>01</strong>1 8<strong>01</strong>/6021/2<strong>01</strong>1Kepala Suku Dinas Pertamanan Kota AdministrasiJakarta BaratAsisten Ekonomi dan Kesejahteraan Sosial Setda KotaTernate07/12/11 12‐12‐2<strong>01</strong>1 168236283000707/12/11 12/12/11 16823627900042271 16/11/2<strong>01</strong>1 800/4081/I.06/2<strong>01</strong>1 Setda Pemkab Lampung Selatan 07/12/11 12/12/11 16823628000002272 16/11/2<strong>01</strong>1 PD.<strong>03</strong>.<strong>01</strong>/At/4852273 16/11/2<strong>01</strong>1 S.1494/SET.2/2<strong>01</strong>12274 16/11/2<strong>01</strong>1 1468/SJ/XI/2<strong>01</strong>1Kepala Balai Besar Wilayah Sungai Cimanuk -CisanggarungSetditjend Planologi Kehutanan KementerianKehutananKabiro Pengawasan Internal Sekretariat KomisiPengawas Persaingan Usaha29/11/11 06‐12‐2<strong>01</strong>1 168236129000029/11/11 06‐12‐2<strong>01</strong>1 168236130000629/11/11 06‐12‐2<strong>01</strong>1 16823615400062275 16/11/2<strong>01</strong>1 1623.1/UN 37.3.1/TU/2<strong>01</strong>1 Sekretaris LPPM Univ. Negeri Semarang 29/11/11 06‐12‐2<strong>01</strong>1 16823614700062276 16/11/2<strong>01</strong>1 050/791/2<strong>01</strong>1 Kepala Bappeda Pemkab Demak 29/11/11 06‐12‐2<strong>01</strong>1 16823612700022277 17/11/2<strong>01</strong>1 UK.120/2/3/UPP.MII-2<strong>01</strong>1 Kakantor Unit Penyelenggara Pelabuhan Malili 29/11/11 06‐12‐2<strong>01</strong>1 16823615800022278 17/11/2<strong>01</strong>1 Kd.23.4/1/KP.00/2361/2<strong>01</strong>1PYMT. Kepala Kantor Kota Manado KementerianAgama2279 17/11/2<strong>01</strong>1 800/2739/Kepeg Setda Pemkab Kayong Utara2280 17/11/2<strong>01</strong>1 4356/PL.430/I.1/11/2<strong>01</strong>1Plh. Sekretaris Badan Plitbang Pertanian KementerianPertanian05/12/11 09‐12‐2<strong>01</strong>1 1682362530006Tidak ada sosialisasi perpres54Tidak ada sosialisasi perpres542281 17/11/2<strong>01</strong>1 500/3697/416-113/2<strong>01</strong>1 Plt. Setda Kab. Mojokerto 29/11/11 07‐12‐2<strong>01</strong>1 16823623600092282 17/11/2<strong>01</strong>1 Sket/94/XI/2<strong>01</strong>1Kepala Lembaga Kesehatan Gigi dan Mulut DinasKesehatan AUSudah pernah dikonversi2283 17/11/2<strong>01</strong>1 <strong>027</strong>/5454/AKP.Aset Setda Prov. Bali 29/11/11 06‐12‐2<strong>01</strong>1 16823613100052284 17/11/2<strong>01</strong>1 050/80.1/680.1/RSUD Dir. RSUD Mokopido Tolitoli 29/11/11 06‐12‐2<strong>01</strong>1 16823615600042285 17/11/2<strong>01</strong>1 050/0453.2/Kesbang Polinmas Kepala Badan Kesbang Pol & Linmas Kab. Tolitoli 29/11/11 07‐12‐2<strong>01</strong>1 1682362380007Hal 109

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2286 17/11/2<strong>01</strong>1 050/4724/Bappeda-Tli Kepala Bappeda Kab. Tolitoli 05/12/11 09‐12‐2<strong>01</strong>1 16823624700052287 18/11/2<strong>01</strong>1 151/SesKab-Wng-<strong>01</strong>2329512/XI/2<strong>01</strong>1 Sekretaris KPU Kab. Wonogiri Sertifikat masih berlaku2288 18/11/2<strong>01</strong>1 384/H1.5.1/Kp.1/20<strong>01</strong> Balai Bahasa Yogyakarta Kemdiknas 29/11/11 06‐12‐2<strong>01</strong>1 16823615200082289 18/11/2<strong>01</strong>1 600/282/04/2<strong>01</strong>1 Asisten Bid. Ekobang Setdakab. Lampung Barat 29/11/11 07‐12‐2<strong>01</strong>1 16823623400<strong>01</strong>2290 18/11/2<strong>01</strong>1 020/749/Satpol.PP-2<strong>01</strong>1 Kepala SatpolPP Prov. Sumatera Barat 29/11/11 07‐12‐2<strong>01</strong>1 16823621100002291 18/11/2<strong>01</strong>1 007/428/Bapp/XI/2<strong>01</strong>12292 18/11/2<strong>01</strong>1 059/143/I.2/VIII/BPBD/2<strong>01</strong>1Kepala Badan Perencanaan Pembangunan Daerah(Bappeda) Pemkab Gunung MasKepala Pelaksana Badan Penanggulangan BencanaDaerah Kab. Gunung Mas05/12/11 09‐12‐2<strong>01</strong>1 168236250000929/11/11 28/12/11 17610471000072293 21/11/2<strong>01</strong>1 W.20-A1/3199/KP.<strong>01</strong>.2/XI/2<strong>01</strong>1 Wakil Ketua Pengadilan Agama Makassar Klas IA 29/11/11 06‐12‐2<strong>01</strong>1 16823615300072294 21/11/2<strong>01</strong>1 1162.1/UN37.3.1/TU/2<strong>01</strong>1 Sekretaris LPPM Univ. Negeri Semarang 06/12/11 09‐12‐2<strong>01</strong>1 16823627500082295 21/11/2<strong>01</strong>1 W22-A5/854/PP.<strong>01</strong>.3/XI/2<strong>01</strong>1 Ketua Pengadilan Agama Bima Klas I-B Sertifikat masih berlaku2296 21/11/2<strong>01</strong>1 S-3<strong>01</strong>/WPJ.06/KP.10<strong>01</strong>/2<strong>01</strong>1Kepala KPP Pratama Jakarta Tanah Abang SatuKanwil DJP Jakpus Ditjend Pajak KementerianKeuanganSertifikat masih berlaku2297 21/11/2<strong>01</strong>1 KU.008/46/KI/DJKA/XI/11 Setditjend Perkeretaapian Kementerian Perhubungan 30/11/11 07‐12‐2<strong>01</strong>1 16823626600002298 21/11/2<strong>01</strong>1 910/4288/415.28/2<strong>01</strong>1 Plt. Kadinas Pendidikan Kab. Jombang 29/11/11 07‐12‐2<strong>01</strong>1 16823626800082299 21/11/2<strong>01</strong>1 30/P2EM/XI/2<strong>01</strong>1 Puslit Ekonomi dan Manajemen Univ. Tanjungpura 05/12/11 09‐12‐2<strong>01</strong>1 16823625100082300 21/11/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>01</strong>-Am/90/2<strong>01</strong>1 Kepala BBWS Brantas Ditjend SDA Kementerian PU 29/11/11 07‐12‐2<strong>01</strong>1 16823619500<strong>03</strong>23<strong>01</strong> 21/11/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>01</strong>-Am/92/2<strong>01</strong>1 Kepala BBWS Brantas Ditjend SDA Kementerian PU 06/12/11 09‐12‐2<strong>01</strong>1 16823625900002302 21/11/2<strong>01</strong>1 - Kabid Kemedikan RSUD Cicalengka Kab. Bandung Sertifikat masih berlaku23<strong>03</strong> 21/11/2<strong>01</strong>1 UM0<strong>01</strong>/545/X/Bdg-2<strong>01</strong>1 Kepala Stasiun Geofisika Kelas I Bandung BMKG Persyartan tidak lengkap2304 21/11/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>01</strong>-An/83 Kepala Balai Besar Wilayah Sungai Bengawan Solo 29/11/11 07‐12‐2<strong>01</strong>1 16823619600022305 22/11/2<strong>01</strong>1 2359/TU.1<strong>01</strong>/B3/2<strong>01</strong>1 Sestama BKKBN 05/12/11 09‐12‐2<strong>01</strong>1 1682362770006Hal 110

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2306 22/11/2<strong>01</strong>1 175/2144/900/04-Peng/XI/2<strong>01</strong>1 Sekretaris DPRD Kab. Kutai Kartanegara Sertifikat masih berlaku2307 22/11/2<strong>01</strong>1 <strong>027</strong>/4<strong>01</strong>7/Adm.Pemb Setda Pemkab Pinrang 30/11/11 09‐12‐2<strong>01</strong>1 16823627200<strong>01</strong>2308 22/11/2<strong>01</strong>1 <strong>027</strong>/2560/404.6.8/2<strong>01</strong>1 Dir. RSUD Kab. Sidoarjo 30/11/11 07‐12‐2<strong>01</strong>1 16823620800062309 22/11/2<strong>01</strong>1 050/2192/BPMN/2<strong>01</strong>1 Kepala Bappeda Kab. Mandailing Natal Persyartan tidak lengkap2310 22/11/2<strong>01</strong>1 800/772/Dalbang-2<strong>01</strong>1 Plt. Setda Kab. Tanah Datar 05/12/11 09‐12‐2<strong>01</strong>1 16823625200072311 22/11/2<strong>01</strong>1 B/3337/XI/2<strong>01</strong>1/Lantas Direktur Lalu Lintas Polda Riau 05/12/11 09‐12‐2<strong>01</strong>1 16823627000<strong>03</strong>2312 22/11/2<strong>01</strong>1 B/74/XI/2<strong>01</strong>1Kepala Subditbinjahrillurja Dit. Ajudan JenderalMabes AD02/04/12 PD02126932313 22/11/2<strong>01</strong>1 DL.107/1/1-PMTM-2<strong>01</strong>1Kepala Puslitbang Manajemen Transportasi MultimodaBalitbang Kementerian Perhubungan05/12/11 09‐12‐2<strong>01</strong>1 16823625800<strong>01</strong>2314 23/11/2<strong>01</strong>1 100/SETDAKAB/556/XI/2<strong>01</strong>1 Setda Pemkab Bolaang Mongondow Timur 30/11/11 07‐12‐2<strong>01</strong>1 1682361990009Tidak melampirkanketerangan mengikutisosialisasi perpres no.54tahun 2<strong>01</strong>02315 23/11/2<strong>01</strong>1 UM.002/419/08/Ad.Kmi-11 Kepala Kantor Administrator Pelabuhan Kumai Sudah pernah dikonversi2316 23/11/2<strong>01</strong>1 1277/J18.1/LL/2<strong>01</strong>1 Kepala LPMP Prov. NAD Kemdiknas 05/12/11 09‐12‐2<strong>01</strong>1 16823627600072317 23/11/2<strong>01</strong>1 367-3/084.6Kepala Sudin Pendidikan Dasar Kota AdministrasiJakarta Barat05/12/11 09‐12‐2<strong>01</strong>1 16823625700022318 23/11/2<strong>01</strong>1 S.311/SMKHUT-1/2<strong>01</strong>1 Kepala Sekolah SMK Kehutanan Negeri Pekanbaru Sertifikat masih berlaku2319 23/11/2<strong>01</strong>1 - Sadirun, Vicky M. Lahamutu, Moh. Zainal Cono 05/12/11 09‐12‐2<strong>01</strong>1 16823627300002320 24/11/2<strong>01</strong>1 700/407DTRPB2321 24/11/2<strong>01</strong>1 UM.<strong>01</strong>.11/BWSK.I/948Kepala Dinas Tata Ruang dan PengawasanPembangunan Daerah Kota ParepareKasubbag TU BWS Kalimantan I Ditjend SDAKalimantan Barat Kementerian PU05/12/11 09‐12‐2<strong>01</strong>1 168236271000205/12/11 09‐12‐2<strong>01</strong>1 16823626900072322 24/11/2<strong>01</strong>1 DP.04/10079/SETJEN/XI/2<strong>01</strong>1 Kabiro Keanggotaan dan Kepegawaian 27/10/11 09/11/11 16823559000072323 24/11/2<strong>01</strong>1 005/LPPN/XI/2<strong>01</strong>1Direktur Program Lembaga PengembanganPengetahuan Nusantara (LPPN)05/12/11 09‐12‐2<strong>01</strong>1 1682362540005Sama dengan <strong>No</strong>. SuratDP.02/5653/SETJEN/VII/2<strong>01</strong>12324 24/11/2<strong>01</strong>1 600/350/Bang-I/10/2<strong>01</strong>1 Plt. Setda Pemkab Berau 05/12/11 09‐12‐2<strong>01</strong>1 16823627400092325 24/11/2<strong>01</strong>1 - M. Adek Rizaldi 05/12/11 12/12/11 1682362440008Hal 111

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2326 25/11/2<strong>01</strong>1 71021.<strong>03</strong>48 Kepala BPS Kab. MinahasaTidak ada sosialisasi perpres542327 25/11/2<strong>01</strong>1 980/459/Diklat Setda Pemkab Belitung 07/12/11 10‐12‐2<strong>01</strong>1 16823624600062328 25/11/2<strong>01</strong>1 690/133/PDAM Pjs. Direktur PDAM Kab. Paser 07/12/11 12/12/11 16823624400082329 25/11/2<strong>01</strong>1 690/134/PDAM Pjs. Direktur PDAM Kab. Paser 07/12/11 12/12/11 16823624400082330 25/11/2<strong>01</strong>1 W25.E5.KU.<strong>03</strong>.<strong>03</strong>-167Kepala Balai Pemasyarakatan Kemenhukham KanwilSulawesi Tenggara07/12/11 12/12/11 16823628100092331 25/11/2<strong>01</strong>1 UM.002/69/1/HLO/2<strong>01</strong>1 Kepala Bandar Udara Haluoleo Persyaratan tidak lengkap2332 25/11/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/BWS.SIV/9852333 25/11/2<strong>01</strong>1 W.25.E9.KP.<strong>01</strong>.02.927Plh. Kepala Balai Wilayah Sungai Sulawesi IV DitjendSDA Kementerian PUKepala Rutan Klas IIB Unaaha Kemhukham KanwilSul. Tenggara07/12/11 09‐12‐2<strong>01</strong>1 1682362480004Tidak ada sosialisasi perpres542334 25/11/2<strong>01</strong>1 - Kepala Dinas KP Prov. Sulawesi Tenggara Sertifikat masih berlaku2335 28/11/2<strong>01</strong>1 154/Seskab-025.433243/XI/2<strong>01</strong>1Sekretaris Komisi Pemilihan Umum (KPU) Kab.Bulukumba2336 28/11/2<strong>01</strong>1 B/1567/XI/2<strong>01</strong>1 Aslog Kodam VI/Mulawarman TNI AD07/12/11 28/12/11 17610473800<strong>03</strong>Tidak ada fotocopysertifikat2337 28/11/2<strong>01</strong>1 A.1526/HK207/TTE.2<strong>01</strong>1 Kepala Bandar Udara Sultan Babullah Ternate 07/12/11 28/12/11 17610468400<strong>03</strong>2338 28/11/2<strong>01</strong>1 PR.<strong>01</strong>.02/P2JN.JTG/2<strong>01</strong>1/340 Kepala Satker P2JN Prov. Jateng 07/12/11 12/12/11 16823624300092339 28/11/2<strong>01</strong>1 3849/-084.2 Kabiro Perekonomian Setda Prov. DKI Jakarta 07/12/11 09‐12‐2<strong>01</strong>1 16823624900<strong>03</strong>2340 28/11/2<strong>01</strong>1 IK.<strong>01</strong>.06/AW/476Kepala BBWS Sungai Mesuji Sekampung DitjendSDA Kementerian PU07/12/11 28/12/11 17610467800022341 28/11/2<strong>01</strong>1 PL<strong>01</strong>.<strong>01</strong>-Av/1096 Kepala BBWS Citarum 07/12/11 28/12/11 17610468900082342 28/11/2<strong>01</strong>1 <strong>027</strong>/1.688 Setda Pemkab Wakatobi 07/12/11 28/12/11 17610474200062343 28/11/2<strong>01</strong>1 <strong>027</strong>/5219/PBD Asisten Administrasi Setda Prov. Jawa Barat 07/12/11 28/12/11 17610466600072344 28/11/2<strong>01</strong>1 1416/UN16.8/TU/2<strong>01</strong>1 Fakultas Teknik Univ. Andalas Padang 07/12/11 12/12/11 16823627800052345 28/11/2<strong>01</strong>1 - Muliadi Sertifikat masih berlaku2346 28/11/2<strong>01</strong>1 0452/268 Setda Pemkab Biak Numfor 07/12/11 28/12/11 1761047410007Hal 112

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2347 28/11/2<strong>01</strong>1 523/1240/XI/DKP/2<strong>01</strong>1Kepala Dinas Kelautan dan Perikanan Pemprov.Sulawesi Barat07/12/11 28/12/11 17610469500092348 28/11/2<strong>01</strong>1 UM.<strong>03</strong>.02/BBWS.CC/II/24 Kepala BBWS Ciliwung Cisadane 07/12/11 12/12/11 16823624200002349 28/11/2<strong>01</strong>1 800/4463/I.1Kabid. Perlindungan dan Rehabilitasi Sosial, DinasSosial Pemprov. DIYTidak ada sosialisasi perpres542350 29/11/2<strong>01</strong>1 690/1091/437.82.207/2<strong>01</strong>1 Dirut PDAM Kab. Gresik 07/12/11 13/12/11 16823634500062351 29/11/2<strong>01</strong>1 UM.002/4/19/AD.PLG-112352 29/11/2<strong>01</strong>1 SP-<strong>01</strong>/WPJ.12/KP.04/2<strong>01</strong>12353 29/11/2<strong>01</strong>1 <strong>027</strong>.521/470/Setdin.Pert/2<strong>01</strong>12354 29/11/2<strong>01</strong>1 71<strong>01</strong>1.0475Administrator Pelabuhan Palembang DitjendPerhubungan Laut Kementerian PerhubunganKepala KPP Pratama Batu Kanwil DJP Jawa Timur IIIDitjend Pajak Kementerian KeuanganKadinas Pertanian, Perikanan dan Peternakan Kab.SekadauKasubbag TU Badan Pusat Statistik (BPS) Kab.Bolaang Mongondow07/12/11 28/12/11 1761046980006Tidak ada sosialisasi perpres54Sertifikat masih berlakuTidak ada sosialisasi perpres542355 29/11/2<strong>01</strong>1 602/217/416/110/2<strong>01</strong>1 Plt. Kadinas PU Bina Marga Kab. Mojokerto 07/12/11 28/12/11 17610469700072356 29/11/2<strong>01</strong>1 KU<strong>03</strong><strong>01</strong>/BWS-BP/754 Kepala BWS Bali - Penida 07/12/11 28/12/11 1761047<strong>01</strong>00092357 29/11/2<strong>01</strong>1 021/1079/APP/XI/2<strong>01</strong>1 Setda Pemkot Mataram 07/12/11 14/12/11 16823647900022358 29/11/2<strong>01</strong>1 KP.104/09/59/Ad.Kdi-11Kepala Kantor Administrator Pelabuhan KendariDitjend Perhubungan Laut Kementerian Perhubungan07/12/11 16/12/11 16823649700082359 29/11/2<strong>01</strong>1 800.08/3138/BPSBTPH/11.11Kepala Balai Pengawasan dan Sertifikasi BenihTanaman Pangan dan Hortikultura Prov. KalimantanSelatanTidak ada sosialisasi perpres542360 29/11/2<strong>01</strong>1 821.2/241/DPU/2<strong>01</strong>1 Kadinas PU Kab. Keerom Sertifikat masih berlaku2361 29/11/2<strong>01</strong>1 523/859/2<strong>01</strong>1 Kadinas Kelautan dan Perikanan Prov. Papua 07/12/11 16/12/11 16823649500002362 29/11/2<strong>01</strong>1 TU.234/LLASDP/XI/2<strong>01</strong>1Kasubbag TU Ditjend Perhubungan Darat KementerianPerhubungan07/12/11 19/12/11 1682364<strong>03</strong>00092363 29/11/2<strong>01</strong>1 700/555/435.108/2<strong>01</strong>1 Kepala Dinas PU Bina Marga Kab. Sumenep 06/12/11 16/12/11 16823649900062364 29/11/2<strong>01</strong>1 800/104/04/2<strong>01</strong>1Asisten Adm Pembangunan dan Kesejahteraan Rakyatsetdakab Sragen2365 29/11/2<strong>01</strong>1 S-217/WPJ.32/KP.<strong>03</strong><strong>01</strong>/2<strong>01</strong>1 Kepala KPP Pratama Kebumen2366 29/11/2<strong>01</strong>1 893.3/124/2/DISHUBKOMINFOKepala Dinas Perhubungan Komunikasi danInformatika Prov. Sumatera Selatan12/12/11 28/12/11 1761047020008Tidak ada sosialisasi perpres54Sudah pernah dikonversiHal 113

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2367 29/11/2<strong>01</strong>1 074/5749/1.2 Kabalai Laboratorium Kesehatan Prov. Jawa Tengah 12/12/11 28/12/11 1761047<strong>03</strong>00072368 29/11/2<strong>01</strong>1 085/BPBD/XI-2<strong>01</strong>1 Kepala BPBD Kab. Minahasa Utara Persyaratan tidak lengkap2369 30/11/2<strong>01</strong>1 800/49/I.05/XI/2<strong>01</strong>1 Kabag Pembangunan Setdakab Pesawaran 12/12/11 28/12/11 17610468800092370 30/11/2<strong>01</strong>1 S-1235/BL.<strong>01</strong>/UP.6/2<strong>01</strong>12371 30/11/2<strong>01</strong>1 620/487.a/DBMP/XI/2<strong>01</strong>12372 30/11/2<strong>01</strong>1 594.3/5672.1Kabag Kepegawaian Sekretariat BPPM dan LembagaKeuangan Kementerian KeuanganKepala Dinas Bina Marga dan Pengairan PemkotSamarindaKepala Dinas Perindustrian dan Perdagangan Pemprov.Jawa Tengah19/12/11 28/12/11 176104687000<strong>01</strong>2/12/11 14/12/11 168236471000<strong>01</strong>2/12/11 19/12/11 16823640200002373 30/11/2<strong>01</strong>1 002/LKI-Konversi/VI/2<strong>01</strong>1 Ketua Lembaga Kajian Indonesia 12/12/11 16/12/11 16823649800072374 30/11/2<strong>01</strong>1 050/593/430.10.9/2<strong>01</strong>12375 30/11/2<strong>01</strong>1 540/511/ESDM/XI/2<strong>01</strong>12376 30/11/2<strong>01</strong>1 550/1107/PHBKI/XI/2<strong>01</strong>1Kepala Dinas Peternakan dan Perikanan Kab.BondowosoKepala Dinas Energi dan Sumber Daya Mineral Kab.DonggalaKepala Dinas Perhubungan Komunikasi danInformatika Pemkab Seruyan12/12/11 28/12/11 176104673000712/12/11 28/12/11 17610470700<strong>03</strong>12/12/11 28/12/11 17610474300052377 30/11/2<strong>01</strong>1 1605/UN50/HM/2<strong>01</strong>1 Rektor Univ. Bangka Belitung 12/12/11 19/12/11 16823649400<strong>01</strong>2378 30/11/2<strong>01</strong>1 S-2704/WPJ.09/2<strong>01</strong>1Kepala Kanwil DJP Jawa Barat I Ditjend PajakKementerian KeuanganTidak ada surat keteranganhilang, Tidak ada sosialisasiperpres 542379 <strong>01</strong>/12/2<strong>01</strong>1 - Hamdinor & Achmad Farihin 12/12/11 19/12/11 16823650000<strong>01</strong>2380 <strong>01</strong>/12/2<strong>01</strong>1 890/PU-UPTJKSDM/1287 Sekretaris Dinas PU Pemprov. Riau 12/12/11 28/12/11 17610465400022381 <strong>01</strong>/12/2<strong>01</strong>1 050/279/BAPPEDA/XI/2<strong>01</strong>1 Sekretaris BAPPEDA Pemkab Balangan 12/12/11 28/12/11 17610470900<strong>01</strong>2382 <strong>01</strong>/12/2<strong>01</strong>1 UM.0<strong>01</strong>/486/BPPP.TTT/KKP/2<strong>01</strong>1Kepala Balai Pelestarian Peninggalan PurbakalaTernate Kementerian Budpar12/12/11 28/12/11 17610467200082383 <strong>01</strong>/12/2<strong>01</strong>1 050/1596/430.10.9/2<strong>01</strong>1 Kadinas Peternakan dan Perikanan Kab. Bondowoso 12/12/11 28/12/11 17610467300072384 <strong>01</strong>/12/2<strong>01</strong>1 AP.893/13<strong>03</strong>b/Kab.RN/2<strong>01</strong>1 Setda Pemkab Rote Ndao 12/12/11 16/12/11 16823649100042385 <strong>01</strong>/12/2<strong>01</strong>1 800/854/08/2<strong>01</strong>12386 05/12/2<strong>01</strong>1 1936/FTP-UGM/LK/2<strong>01</strong>1Sekretaris Dinas PU, Perumahan, Pertambangan danEnergi Pemkab DemakKepala Kantor Administrasi FT Pertanian Univ. GajahMada12/12/11 14/12/11 16823647000<strong>01</strong>12/12/11 16/12/11 1682364960009Hal 114

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2387 05/12/2<strong>01</strong>1 237/UN33.9/PM/2<strong>01</strong>1 Sekretaris LPM Univ. Negeri Medan 12/12/11 14/12/11 16823647200092388 05/12/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>01</strong>-Am/94/2<strong>01</strong>1 Kepala BBWS Brantas Ditjend SDA Kementerian PU 12/12/11 19/12/11 16823648800002389 05/12/2<strong>01</strong>1 890/816/PEG/XI/2<strong>01</strong>1Kepala Dinas Perhubungan, Komunikasi danInformatika Pemprov. Kalimantan Tengah12/12/11 19/12/11 16823622900092390 05/12/2<strong>01</strong>1 13<strong>01</strong>1/TU.220/F2.K/10.11Kepala Balai Besar Indseminasi Buatan SingosariDitjend Peternakan dan Kesehatan Hewan KementerianPertanian12/12/11 28/12/11 17610470800022391 05/12/2<strong>01</strong>1 050/388/4<strong>01</strong>.<strong>01</strong>2/2<strong>01</strong>12392 05/12/2<strong>01</strong>1 S.1329/Set-2/2<strong>01</strong>12393 05/12/2<strong>01</strong>1 <strong>027</strong>/5312/Admbang2394 05/12/2<strong>01</strong>1 893/2422/2<strong>01</strong>1Asisten Pemerintahan dan Pembangunan Setda PemkotMadiunPlt. Setditjend Bina Usaha Kehutanan KementerianKehutananKabiro Adm. Pembangunan Setda Pemprov. JawaBaratKepala Dinas Kehutanan dan Perkebunan PemkabPidie12/12/11 28/12/11 176104705000512/12/11 28/12/11 176104706000412/12/11 14/12/11 1682364690005Sertifikat masih berlaku2395 05/12/2<strong>01</strong>1 028/05192/04/2<strong>01</strong>1 Setda Pemkab Boyolali 12/12/11 16/12/11 16823649000052396 05/12/2<strong>01</strong>1 - Irfan H. Adipu Persyaratan tidak lengkap2397 05/12/2<strong>01</strong>1 12/IAPI/SP/XI/2<strong>01</strong>1 Wasesjend DPP IAPI 12/12/11 16/12/11 17610470500052398 05/12/2<strong>01</strong>1 KU<strong>03</strong><strong>01</strong>/BWS-BP/763 Kepala BWS Bali - Penida Sudah pernah dikonversi2399 05/12/2<strong>01</strong>1 - Kepala Dinas PU Kab. Bolaang Mongondow Utara Persyaratan tidak lengkap2400 05/12/2<strong>01</strong>1 71061.143 Kepala BPS Kab. Minahasa Utara Persyaratan tidak lengkap24<strong>01</strong> 05/12/2<strong>01</strong>1 Sti.12.Kp.<strong>01</strong>.1/2043.a/2<strong>01</strong>1 Pgs Ketua STAIN Manado Persyaratan tidak lengkap2402 05/12/2<strong>01</strong>1 824/638/XI/2<strong>01</strong>1 Kepala Dinas Kesehatan Kab. Konawe Utara24<strong>03</strong> 06/12/2<strong>01</strong>1 050/194/DPUP/M/XI/2<strong>01</strong>1 Kadinas PU dan Perumahan Kab. MamasaTidak melampirkanketerangan mengikutisosialisasi perpres no.54tahun 2<strong>01</strong>0Sertifikat masih berlaku danTidak ada sosialisasiperprers2404 06/12/2<strong>01</strong>1 1791.a/BKD-06/XI/2<strong>01</strong>1Kabalai Diklat Badan Kepegawaian, Diklat Pemprov.Kepulauan Riau12/12/11 28/12/11 1761046670006Hal 115

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2405 06/12/2<strong>01</strong>1 S.653/BTNKJ.1.4/2<strong>01</strong>1Kepala Balai Taman Nasional Karimunjawa DitjendPerlindungan Hutan dan Konservasi Alam KementerianKehutanan12/12/11 28/12/11 17610468200052406 06/12/2<strong>01</strong>1 PD.<strong>01</strong>.07.CSI/3312407 06/12/2<strong>01</strong>1 600/708.1-DBT/2<strong>01</strong>1Kabag Kepegawaian dan Ortala Setditjend Cipta KaryaKementerian PUKepala Dinas Bina Marga dan Tata Ruang Prov.Banten12/12/11 28/12/11 1761046560000Tidak ada sosialisasi perpres542408 06/12/2<strong>01</strong>1 600/300/DPUP/KY/XI/2<strong>01</strong>1 Kadinas PU dan Perumahan Kab. Kep, Yapen 12/12/11 28/12/11 17610467000002409 06/12/2<strong>01</strong>1 B/836/XII/2<strong>01</strong>1/Sepolwan Kepala Sekolah Polisi Wanita 12/12/11 29/12/11 17610465700092410 06/12/2<strong>01</strong>1 050/596/430.10.9/2<strong>01</strong>1 Kadinas Peternakan dan Perikanan Kab. BondowosoSertifikat masih berlaku,sudah diajukan konversi2411 06/12/2<strong>01</strong>1 W.24-U2/919/UM.<strong>01</strong>.10/XI/2<strong>01</strong>1 Ketua Pengadilan Negeri Singaraja 12/12/11 28/12/11 17610467400062412 06/12/2<strong>01</strong>1 441.3/2731/UP/RSJ/2<strong>01</strong>1 Dirut RSJ Daerah Prov. Jambi 12/12/11 28/12/11 17610465500<strong>01</strong>2413 06/12/2<strong>01</strong>1 B.727/KP3K.5/XI/2<strong>01</strong>1Direktur Pemberdayaan Masyarakat danPengembangan Usaha Ditjend Kelautan, Pesisir danpulau-pulau kecil Kementerian KP12/12/11 13/12/11 16823630700062414 06/12/2<strong>01</strong>1 168/AU.2/XI/AKPAR-2<strong>01</strong>1 Direktur Akademi Pariwisata Negeri Medan 12/12/11 16/12/11 16823648900092415 06/12/2<strong>01</strong>1 1671/006.1/TU/2<strong>01</strong>1Koordinator Perguruan Tinggi Swasta Wilayah VIKemdiknas12/12/11 16/12/11 16823648700<strong>01</strong>2416 07/12/2<strong>01</strong>1 <strong>027</strong>/4794/404.1.2.2/2<strong>01</strong>1 Setda Pemkab Sidoarjo 12/12/11 28/12/11 17610472700072417 07/12/2<strong>01</strong>1 890/PU-UPTJKSDM/1324 Sekretaris Dinas PU Pemprov. Riau 12/12/11 29/12/11 17610465800082418 07/12/2<strong>01</strong>1 425/PPS/XI/2<strong>01</strong>1 Kepala Pusat Penyuluhan Sosial Kementerian Sosial 12/12/11 29/12/11 17610466000<strong>03</strong>2419 07/12/2<strong>01</strong>1 800/KD-PU/849 Kadinas PU Prov. Sulawesi Utara 12/12/11 10/<strong>01</strong>/12 TIKI2420 07/12/2<strong>01</strong>1 050/4257 Setda Pemkot Surakarta 12/12/11 29/12/11 17610466100022421 07/12/2<strong>01</strong>1 W15-A2/1445/OT-0<strong>01</strong>/XII/2<strong>01</strong>1 Ketua Pengadilan Agama Kelas I-B Amuntai2422 07/12/2<strong>01</strong>1 S.964/VI/BPPHP-XI/2/2<strong>01</strong>1Kepala Balai Pemantauan Pemanfaatan Hutan ProduksiWilayah XI Ditjend Bina Usaha KehutananKementerian Kehutanan12/12/11 29/12/11 17610466200<strong>01</strong>Tidak ada sosialisasi perpres54Hal 116

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2423 07/12/2<strong>01</strong>1 PR.<strong>01</strong>.02/PJNMS/02Kepala Satker Pelaksanaan Jalan NasionalMetropolitan Semarang, Balai Besar Pelaksanaan JalanNasional V Ditjend Bina Marga12/12/11 29/12/11 17610465900072424 07/12/2<strong>01</strong>1 B/240/XI/2<strong>01</strong>1/Rosarpras Kepala Biro Sarpras Polda Sulteng 12/12/11 29/12/11 17610468600<strong>01</strong>2425 07/12/2<strong>01</strong>1 391/SesProv-006/XII/2<strong>01</strong>1 Set KPU Prov. Sumatera Selatan2426 07/12/2<strong>01</strong>1 050/306.1/Bappeda/XI/2<strong>01</strong>1 Set. Bappeda Pemkab Balangan2427 07/12/2<strong>01</strong>1 PS.108/D.1715/BPSDMP.2<strong>01</strong>1 Set. Badan Pengembangan SDM Perhubungan2428 07/12/2<strong>01</strong>1 11.28/BMSDA-KS/UM/XII/2<strong>01</strong>1Kepala Dinas Bina Marga dan SDA Kab. KuantanSingingi12/12/11 28/12/11 1761047280006Tidak ada fotocopysertifikatTidak ada fotocopysertifikatTidak ada fotocopysertifikat2429 08/12/2<strong>01</strong>1 246/DISBUDPAR/XI/2<strong>01</strong>1 Kepala dinas Kebudayaan dan Pariwisata Kota Palopo Persyaratan tidak lengkap2430 08/12/2<strong>01</strong>1 Ma.23.<strong>01</strong>/PP.00.6/648/2<strong>01</strong>1 Kepala MAN model Manado Sertifikat masih berlaku2431 08/12/2<strong>01</strong>1 KP.04.04.1/XII/755/2<strong>01</strong>1 Direktur Politeknik Kesehatan Kendari 12/12/11 29/12/11 17610466300002432 08/12/2<strong>01</strong>1 2549/RSUDLB/UM/XII/2<strong>01</strong>1 Dir. RSUD Labuang Baji 12/12/11 29/12/11 17610466400092433 08/12/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/222/XI/2<strong>01</strong>1 Sekretrais Dinas PU Prov. NTT 12/12/11 29/12/11 17610462900062434 08/12/2<strong>01</strong>1 W9-U/2804/UM.10.10/XI/2<strong>01</strong>1 Panitera/Sekretrais Pengadilan Tinggi Tanjungkarang 12/12/11 29/12/11 17610462700082435 08/12/2<strong>01</strong>1 5456/PL1.R/LK/2<strong>01</strong>1 Direktur Politeknik Negeri BandungTidak ada fotocopysertifikat2436 08/12/2<strong>01</strong>1 <strong>027</strong>/9772/Perenc Kepala Dinas Perikanan dan Kelautan Prov. Jawa Barat 12/12/11 29/12/11 17610463000022437 08/12/2<strong>01</strong>1 AU/13626/Pegum.3324/XII/2<strong>01</strong>12438 08/12/2<strong>01</strong>1 800/4.421/PSDA-KB/2<strong>01</strong>1Sekretaris Ditjend Perhubungan Udara KementerianPerhubunganKepala UPTPSDA Kualuh Barumun Dinas PSDAProv. Sumatera Utara<strong>03</strong>/<strong>01</strong>/12 17/<strong>01</strong>/12 02<strong>01</strong>24562793Tidak ada fotocopysertifikat2439 08/12/2<strong>01</strong>1 UM.002/1339/XII/Plu-2<strong>01</strong>1 Kepala Bandar Udara Mutiara 12/12/11 29/12/11 17610462800072440 08/12/2<strong>01</strong>1 W15.E10.PL.02.<strong>03</strong>-372Kepala Lembaga Permasyarakatan Klas IIB TakalarKanwil Sulawesi Selatan Kementerian Hukum danHAM <strong>No</strong>. 121 Takalar 92213, Telp. (0418) 21187,21242, Fax. 21187Tidak ada sosialisasi perpres54Hal 117

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2441 09/12/2<strong>01</strong>1 890/902/Diklat-KM/2<strong>01</strong>1 Kepala Kantor Diklat Kota Medan 02/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2442 09/12/2<strong>01</strong>1 440.<strong>027</strong>/4616/SEKRT/2<strong>01</strong>1 Kadinas Kesehatan Kab. Kutai Kartanegara 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141537<strong>01</strong>2443 09/12/2<strong>01</strong>1 UM.<strong>01</strong>.02/BBWS-PJ/891 KA BBWS Pompengan Jeneberang 14/12/11 29/12/11 17610463200002444 09/12/2<strong>01</strong>1 893.3/.... Kepala BKD Pemkab Semarang 09/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625112445 09/12/2<strong>01</strong>1 3399/0811 Kadinas Pertamanan dan Pemakaman Prov. DKI Jkt 14/12/11 28/12/11 17610467700<strong>03</strong>2446 09/12/2<strong>01</strong>1 W4.A/1533/PL.06/XI/2<strong>01</strong>1 Wakil Ketua Pengadilan Tinggi Agama Pekanbaru 14/12/11 28/12/11 17610467900<strong>01</strong>2447 09/12/2<strong>01</strong>1 893/30<strong>01</strong>/BKD Kepala BKD Pemkab Sleman 14/12/11 28/12/11 17610467600042448 09/12/2<strong>01</strong>1 893.3/<strong>01</strong>/XII/2<strong>01</strong>12449 09/12/2<strong>01</strong>1 B.859/Setpres/D-1/I-Bgr/DW.<strong>01</strong>.00/12/2<strong>01</strong>1KA Balai Pelaksana Teknis Bina Marga WilayahSemarang14/12/11 28/12/11 1761046810006Kepala Istana Kepresidenan Bogor 14/12/11 28/12/11 17610467100092450 12/12/2<strong>01</strong>1 800/441/7/2<strong>01</strong>1 Kepala BKPM Wil. Semarang 14/12/11 28/12/11 17610468500022451 12/12/2<strong>01</strong>1 893.3-1494/KPU.BJ/XI/2<strong>01</strong>1 Sekretaris KPU Kota Binjai Sertifikat masih berlaku2452 12/12/2<strong>01</strong>1 S.1<strong>01</strong>1/IV-T.10/PKK/2<strong>01</strong>1Kepala Balai Taman Nasional Ujung Kulon DitjendPerlindungan dan Konservasi Alam KementerianKehutananSertifikat masih berlaku2453 12/12/2<strong>01</strong>1 020/116/Adm Pemb/2<strong>01</strong>1 Setda Pemkab Lombok Barat <strong>03</strong>/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2454 12/12/2<strong>01</strong>1 05/LPPN/XII/2<strong>01</strong>1Dir. Program Lembaga Pengembangan PengetahuanNusantara (LPPN)14/12/11 28/12/11 17610466800052455 12/12/2<strong>01</strong>1 <strong>027</strong>/2726/Dikbun Kepala Dinas Perkebunan Prov. Bali 14/12/11 28/12/11 17610467500052456 12/12/2<strong>01</strong>1 Sti.04.1/KP.<strong>01</strong>.2/2778/2<strong>01</strong>1 Ketua STAIN Sjech M. Djamil Djambek Bukittinggi 14/12/11 28/12/11 17610466900042457 12/12/2<strong>01</strong>1 1979/-1.862Kepala Kantor Kesatuan Bangsa dan Politik Adm.Jakarta Pusat2458 12/12/2<strong>01</strong>1 B/998/XII/2<strong>01</strong>1 Sekretaris Irjend MabesAD 19/12/11 Proses14/12/11 28/12/11 1761046830004Tidak ada alamatpengiriman sertifikat2459 12/12/2<strong>01</strong>1 674/UM/PSP/XI/2<strong>01</strong>1KPA Satker Pengembangan Sarana PerkeretaapianDitjend Perkeretaapian Kementerian Perhubungan14/12/11 29/12/11 17610463100<strong>01</strong>Hal 118

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2460 12/12/2<strong>01</strong>1 DM.<strong>03</strong>.02.1.14/8434/2<strong>01</strong>1 RS Kusta Dr. Rivai Abdullah Palembang 08/<strong>03</strong>/12 02<strong>01</strong>28866341 Surat Keterangan Pelatihan2461 13/12/2<strong>01</strong>1 005/662/XI/Minbang/LK-2<strong>01</strong>1 Setda Pemkab Lima Puluh Kota 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141536992462 13/12/2<strong>01</strong>1 1243/SJ.3/KOMINFO/12/2<strong>01</strong>12463 13/12/2<strong>01</strong>1 UM.0<strong>03</strong>/4/3/DNG.Smr-11Kabiro Keuangan Setjend Kementerian Komunikasidan InformatikaKepala Distrik Navigasi Kelas I Samarinda DitjendPerhubungan Laut Kementerian Perhubungan05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI27/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141537132464 13/12/2<strong>01</strong>1 550/308/XI/DISHUBKOMINFOKepala Dinas Perhubungan Kominfo Pemprov.Sulawesi Barat27/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141536982465 13/12/2<strong>01</strong>1 B/11643/X/2<strong>01</strong>1/Rp Sarpras Kabiro Sarana Dan Prasarana Polda Jawa Barat 04/04/12 PD02127422466 13/12/2<strong>01</strong>1 S-1288/WBC.15/KPP.MP.<strong>01</strong>/2<strong>01</strong>1Kepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe Madya Pabean Makassar Kanwil SulawesiDitjend Bea dan Cukai Kem. Keuangan27/12/11 10/<strong>01</strong>/12 02<strong>01</strong>14153709Sertifikat masih berlaku,Tidak melampirkanketerangan mengikutisosialisasi perpres no.54tahun 2<strong>01</strong>02467 13/12/2<strong>01</strong>1 - Lalu Saladin Jufri 29/12/11 12/<strong>01</strong>/12 TIKI2468 13/12/2<strong>01</strong>1 924/U/P2L/XII/2<strong>01</strong>1KPA Satker Pengembangan Perkeretaapian LampungDitjend Perkeretaapian Kementerian PerhubunganTidak ada sosialisasi perpres542469 13/12/2<strong>01</strong>1 334/B.5/XII/2<strong>01</strong>1 Setda Pemkab Mukomuko 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141536972470 13/12/2<strong>01</strong>1 0245/UN30.6/JA/2<strong>01</strong>1Ketua Jurusan Akuntansi Fak. Ekonomi Univ.Bengkulu29/12/11 Proses2471 13/12/2<strong>01</strong>1 <strong>01</strong>6/160/I.041/2<strong>01</strong>1 Setdakota Bandar Lampung 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>192952982472 13/12/2<strong>01</strong>1 6243/DPB/KU.610.S1/XII/2<strong>01</strong>1Setditjend Perikanan Budidaya Kementerian Kelautandan Perikanan27/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141537082473 13/12/2<strong>01</strong>1 <strong>027</strong>/1340 Sekretaris BKD Pemkab Gunungkidul 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141537042474 13/12/2<strong>01</strong>1 5<strong>03</strong>/47/Pemb/III/2<strong>01</strong>1 Setda Kota Palopo 29/12/11 10/<strong>01</strong>/11 02<strong>01</strong>192953<strong>01</strong>2475 13/12/2<strong>01</strong>1 UM.<strong>01</strong>.02/BBWS-PJ/897 Kepala BBWS Pompengan Jeneberang 29/12/11 12/<strong>01</strong>/12 TIKI2476 13/12/2<strong>01</strong>1 050/2<strong>03</strong>7/BLPBJ/2<strong>01</strong>1 Sekretaris Daerah Kab. Mandailing Natal <strong>03</strong>/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKIHal 119

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2477 14/12/2<strong>01</strong>1 Sket-02/Setneg/PPKK/Dirut/12/2<strong>01</strong>12478 14/12/2<strong>01</strong>1 3476/-084Dirut Pusat Pengelolaan Komplek KemayoranSekretariat NegaraKepala Sudin Perindustrian dan Energi Kota Adm.Jakarta Barat, Dinas Perindustrian dan EnergiPemprov. DKI Jakarta29/12/11 25/<strong>01</strong>/12 02<strong>01</strong>24562785Surat permohonan konversi2479 14/12/2<strong>01</strong>1 045.2/84/BM/XII/2<strong>01</strong>1 Sekretaris Bina Marga Kab. Luwu Pemkab Luwu 29/12/11 13/<strong>01</strong>/12 TIKI2480 14/12/2<strong>01</strong>1 1173/KU.510/K.1/12/2<strong>01</strong>1Sekretaris Badan Ketahanan Pangan KementerianPertaniantidak melampirkan fotocopysertifikat2481 14/12/2<strong>01</strong>1 893/6858 Kepala BKD Pemkot Yogyakarta 02/<strong>01</strong>/12 12/<strong>01</strong>/12 02<strong>01</strong>141537192482 14/12/2<strong>01</strong>1 Sti.08/I/KS.02.2/.../2<strong>01</strong>1 Ketua STAIN Kediri 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141536942483 14/12/2<strong>01</strong>1 B.500/P2KTrans-PTPKT/XI/2<strong>01</strong>12484 15/12/2<strong>01</strong>1 Un.04/DirekturLPPSH/PP.00.09/66/2<strong>01</strong>1Direktur Perencanaan Teknis Pembangunan KawasanTransmigrasiDirektur Lembaga Penerangan dan Penyuluhan Syariahdan Hukum (LPPSH) UIN Sultan Syarif Kasim Riau29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>1929530629/12/11 16/<strong>01</strong>/12 TIKI2485 15/12/2<strong>01</strong>1 893.3/1688/435.2<strong>03</strong>/2<strong>01</strong>1 Setda Pemkab Sumenep 09/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>245627782486 15/12/2<strong>01</strong>1 800/432/LPD.3/2<strong>01</strong>12487 15/12/2<strong>01</strong>1 900/1349/BPBD/2<strong>01</strong>1Kepala Pelaksana Badan Penanggulangan BencanaDaerah Kab. Lampung TengahKepala Badan Penanggulangan Bencana Daerah Kab.Tolitoli2488 15/12/2<strong>01</strong>1 KP.<strong>01</strong>02/BWS/MU/97 Kepala BWS Maluku Utara2489 15/12/2<strong>01</strong>1 UM<strong>01</strong><strong>03</strong>-Ku/386Kapus Pembinaan Usaha dan Kelembagaan BadanPembinaan Konstruksi Kementerian PU29/12/11 08/<strong>03</strong>/12 PD0208695 Sudah pernah dikonversi29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>1929529906/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>13988494Tidak ada fotocopysertifikat2490 15/12/2<strong>01</strong>1 1325/SJ-DAG.3/SD/12/2<strong>01</strong>1 Kabiro Keuangan Setjend Kementerian Perdagangan 29/12/11 24/<strong>01</strong>/12 02<strong>01</strong>245629122491 15/12/2<strong>01</strong>1 600/321/04/2<strong>01</strong>1 Setda Pemkab Lampung Barat 10/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245629272492 15/12/2<strong>01</strong>1 910/5471/415.10.5/2<strong>01</strong>1 Setda Pemkab Jombang 10/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245628312493 15/12/2<strong>01</strong>1 690/522.1/PDAM/XII/2<strong>01</strong>1 Dirut PDAM Kab. Donggala Sulawesi Tengah Sertifikat masih berlaku2494 16/12/2<strong>01</strong>1 310/PPE.3/KLH/12/2<strong>01</strong>1Kapus Pengelolaan Ekoregion Bali & NusaTenggara/KPA Kementerian Lingkungan Hidup29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>19295319Hal 120

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2495 16/12/2<strong>01</strong>1 S-910/WBC.14/KPP.04/2<strong>01</strong>1Plh. Kepala Kantor Pengawasan dan Pelayanan Beadan Cukai Tipe Madya Pabean C Tarakan,Kementerian Keuangan Ditjend Bea dan Cukai KanwilKalimantan Bag. TimurFotocopy sertifikat tidakjelas2496 16/12/2<strong>01</strong>1 PU.600/495/2<strong>01</strong>1 Plh. Kadinas PU Kab. Alor 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>192953152497 16/12/2<strong>01</strong>1 CPP.100/120/2<strong>01</strong>1 Camat Pulau Pura Pemkab Alor 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>192953172498 16/12/2<strong>01</strong>1 S-4468/WBC.11/KPP.MC.<strong>01</strong>/2<strong>01</strong>12499 16/12/2<strong>01</strong>1 2<strong>01</strong>2/TU.200/F2.I/12/2<strong>01</strong>1Kepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe Madya Cukai Malang Ditjend Bea danCukai Kementerian KeuanganKepala Balai Embrio Ternak Cipelang, DitjendPeternakan dan Kesehatan Hewan KementerianPertanian09/<strong>03</strong>/12 PD020871610/<strong>01</strong>/11 26/<strong>01</strong>/12 02<strong>01</strong>245625072500 16/12/2<strong>01</strong>1 931.1/FTP-UGM/KP/2<strong>01</strong>1Ketua Pusat Kerjasama dan Kewirausahaan UIN SunanGunung Djati Bandung02/<strong>01</strong>/12 18‐‐1‐2<strong>01</strong>2 02<strong>01</strong>2456293025<strong>01</strong> 19/12/2<strong>01</strong>1 560/42690/120.11/2<strong>01</strong>1 Sekretaris Dinas Pendapatan Pemprov. Jawa Timur 10/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>24562730Tidak ada sosialisasi perpres542502 19/12/2<strong>01</strong>1 644/2.35.09/XII/2<strong>01</strong>1Kakantor Pertanahan Kab. Jember Padan PertanahanNasional RI Prov. Jatim29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>1415370025<strong>03</strong> 19/12/2<strong>01</strong>1 W3-A/2212/OT.1.<strong>01</strong>/XII/2<strong>01</strong>1 Ketua Pengadilan Tinggi Agama Padang 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>141537022504 19/12/2<strong>01</strong>1 524/1712/Prog/DPPKKepala Dinas Peternakan Perikanan dan Kelautan Kab.Tasikmalaya2505 19/12/2<strong>01</strong>1 UM002/3/3/DNG.PLG-2<strong>01</strong>1 Kadistrik Navigasi Kelas I Palembang 29/12/11 10/<strong>01</strong>/12 02<strong>01</strong>19295318Tidak ada sosialisasi perpres542506 19/12/2<strong>01</strong>1 800/1916/V/2<strong>01</strong>1 Setda Kab. Bangka 10/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>245629572507 19/12/2<strong>01</strong>1 470/532/dukcapil/2<strong>01</strong>1 Kadinas Kependudukan dan Catatan Sipil Kab. Bangli2508 19/12/2<strong>01</strong>1 W20-A/1982/PP.<strong>01</strong>/XII/2<strong>01</strong>1Panitera/Sekretaris Pengadilan Tinggi AgamaMakassar02/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629342509 19/12/2<strong>01</strong>1 800/254/2<strong>01</strong>1 Setda Pemkab Rembang 02/<strong>01</strong>/12 Proses2510 19/12/2<strong>01</strong>1 Pemb.500/299/53.17/XI/2<strong>01</strong>1 Bagian Pembangunan Setda Pemkab Sumba TengahTidak ada soialisasi perpres54Sama dengan <strong>No</strong>. SuratPemb.500/22/53.17/I/2<strong>01</strong>22511 19/12/2<strong>01</strong>1 690/526/PDAM/XII/2<strong>01</strong>1 Dirut PDAM Kab. Donggala Sulawesi Tengah 29/12/11 12/<strong>01</strong>/12 TIKI2512 19/12/2<strong>01</strong>1 600-306/Bang.I/XII/2<strong>01</strong>1 Setda Pemkab Kutai Kartanegara tidak ada fotocopy sertifikat2513 19/12/2<strong>01</strong>1 - Farida Napu 10/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>24562931Hal 121

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2514 19/12/2<strong>01</strong>1 055/4229/416-<strong>01</strong>4/2<strong>01</strong>1 Kabag Humas dan Protokol Setda Pemkab Mojokerto 02/<strong>01</strong>/12 10/<strong>01</strong>/12 TIKI2515 19/12/2<strong>01</strong>1 800/236/413.023/2<strong>01</strong>1 Setda Pemkab Lamongan 02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>141536952516 19/12/2<strong>01</strong>1 1624/SJ/XII/2<strong>01</strong>1Setjend Sekretariat Komisi Pengawas PersainaganUsaha (KPPU)04/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629132517 19/12/2<strong>01</strong>1 PL.04.<strong>01</strong>.3/1902/2<strong>01</strong>1Kabiro Keuangan dan Barang Milik Negara SetjendKementerian Kesehatan04/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245628502518 19/12/2<strong>01</strong>1 884/Ses-Prov-<strong>01</strong>2/09/XII/2<strong>01</strong>1 Sekretaris KPU Prov. Jawa Tengah 05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2519 19/12/2<strong>01</strong>1 600/554/<strong>03</strong> Setda Pemkab Klaten 06/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>245628432520 19/12/2<strong>01</strong>1 1598/PSPA-TU/PB.<strong>03</strong>.<strong>01</strong>/XII/2<strong>01</strong>1Kasubbag TU Panti Sosial Petirahan Anak (PSPA)"Satria "BAturadenDitjend Pelayanan dan RehabilitasiSosial KemsosTidak ada sosialisasi perpres542521 20/12/2<strong>01</strong>1 2066/FTP-UGM/LK/2<strong>01</strong>1 Kepala Kantor Administrasi FTP Univ. Gajahmada 10/<strong>01</strong>/12 17/<strong>01</strong>/12 02<strong>01</strong>245629992522 20/12/2<strong>01</strong>1 <strong>027</strong>/223/I/Dislutkan/2<strong>01</strong>1Kepala Dinas Kelautan dan Perikanan ProvinsiSumatera Selatan21/12/11 21/12/11 TIKI2523 20/12/2<strong>01</strong>1 210458/J.19/LL/2<strong>01</strong>1 Kepala LPMP Prov. Sumatera Utara 02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>192953162524 20/12/2<strong>01</strong>1 UM0<strong>01</strong>/44/6/Sekjen/KPEK/2<strong>01</strong>1Sekretaris Jenderal Kementerian Pariwisata danEkonomi Kreatif02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>141537122525 20/12/2<strong>01</strong>1 441.3/2899/RSJD/XII/2<strong>01</strong>1 Dirut RSJ Daerah Prov. Jambi 02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>141537142526 20/12/2<strong>01</strong>1 264/078.4Lurah Gunung Sahari Selatan Kec. Kemayoran PemkotJakarta Pusat02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>192953002527 20/12/2<strong>01</strong>1 939/UN19.2/PL/2<strong>01</strong>1 Sekretaris Lemlit Univ. Riau 02/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2528 20/12/2<strong>01</strong>1 PD.<strong>03</strong>.02-SL.09/142Kepala Balai Diklat Wilayah IX Jayapura PusdiklatSetjend Kementerian PU02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>192953132529 20/12/2<strong>01</strong>1 UM<strong>03</strong>.02/BBWS.CC/XII/394.1 Kepala BBWS Ciliwung Cisadane 02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>141537162530 20/12/2<strong>01</strong>1 -Kepala Bagian Umum Ditjend Pengelolaan danPemasaran Hasil Pertanian Kementerian Pertanian02/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2531 20/12/2<strong>01</strong>1 500/Setda-KK/07/80/XII/2<strong>01</strong>1 Sekretrais Daerah Pemkot Kotamobagu 09/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245628952532 20/12/2<strong>01</strong>1 B/1956/XII/2<strong>01</strong>1 Karosarpras Polda Kep. Bangka Belitung 02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>19295309Hal 122

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2533 21/12/2<strong>01</strong>1 PR.<strong>01</strong>.02.212.12.11.3458 Kabiro Perencanaan dan Keuangan Badan POM RI 04/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245628402534 21/12/2<strong>01</strong>1 UM.002/17/18/PPSDMPD-2<strong>01</strong>1 Kapus Pengembangan SDM Perhubungan DaratTidak ada fotocopysertifikat2535 21/12/2<strong>01</strong>1 UM.0<strong>03</strong>/1/4/UPP.Sny-11 Kepala Kantor Unit Penyelenggara Pelabuhan 04/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKI2536 21/12/2<strong>01</strong>1 893.3/1068 Direksi PDAM Tirta Moedal Pemkot Semarang 04/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245628412537 21/12/2<strong>01</strong>1 UM.007/3/4-BLTL-2<strong>01</strong>12538 21/12/2<strong>01</strong>1 UM.107/1/2-PMTM-2<strong>01</strong>12539 21/12/2<strong>01</strong>1 -Kepala Puslitbang Perhubungan Laut BalitbangKementerian PerhubunganKepala Puslitbang Manajemen Transportasi MultimodaBalitbang Kementerian PerhubunganLembaga Pengembangan & Konsultasi Nasional(LPKN)04/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>2456273105/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI12/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>245627842540 21/12/2<strong>01</strong>1 PU.BPBT.05.<strong>01</strong>/602/223/XII/2<strong>01</strong>1 Kepala Dinas PU Prov. NTT 05/<strong>01</strong>/12 26/<strong>01</strong>/12 TIKI2541 21/12/2<strong>01</strong>1 B.19.06/BBAT.MDG/PL.610/XII/2<strong>01</strong>12542 21/12/2<strong>01</strong>1 KP.405/1/7Phb2<strong>01</strong>1Kepala Balai Budidaya Air Tawar Mandangin DirjendPerikanan Budidaya Kementerian Kelautan danPerikananKabiro Keuangan dan Perlengkapan SetjendKementerian Perhubungan05/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKI05/<strong>01</strong>/12 17/<strong>01</strong>/12 02<strong>01</strong>245629782543 21/12/2<strong>01</strong>1 <strong>027</strong>/6090/2<strong>01</strong>1 Kepala Badan Kepegawaian, Diklat Pemerintah Aceh 05/<strong>01</strong>/12 13/<strong>01</strong>/12 TIKI2544 21/12/2<strong>01</strong>1 UM.0<strong>03</strong>/B/5/UPP.BTG-112545 21/12/2<strong>01</strong>1 <strong>027</strong>/1079-B/BPBD/XII/2<strong>01</strong>12546 21/12/2<strong>01</strong>1 045.4/1957/2<strong>01</strong>12547 21/12/2<strong>01</strong>1 <strong>027</strong>/1077/BPBD/XII/2<strong>01</strong>1Kepala Kantor Unit Penyelenggara Pelabuhan Kelas IIIBatangKepala Pelaksana Badan Penanggulangan BencanaDaerah Prov. Jawa BaratKepala Dinas Tanaman Pangan dan HortikulturaPemkab GarutKepala Pelaksana Badan Penanggulangan BencanaDaerah Prov. Jawa Barat05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI02/<strong>01</strong>/12 10/<strong>01</strong>/12 02<strong>01</strong>14153710Tidak ada sosialisasi perpres54Tidak ada sosialisasi perpres542548 21/12/2<strong>01</strong>1 3149/H11.1.12/TU/2<strong>01</strong>1 Dekan FE Univ. Syiah Kuala 05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2549 21/12/2<strong>01</strong>1 192/RSUD/XI/2<strong>01</strong>1 Direktur RSUD OHEO Kab. Konawe Utara Surat permohonan konversi2550 21/12/2<strong>01</strong>1 800/2<strong>03</strong>3-DP4/2<strong>01</strong>1 Kepala Dinas PU Prov. Jambi 06/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2551 22/12/2<strong>01</strong>1 <strong>01</strong>6/172/1.04/2<strong>01</strong>1 Sekretaris Daerah Kota Bandar Lampung 05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2552 22/12/2<strong>01</strong>1 045.4/125/II/2<strong>01</strong>1Kepala Dinas Komunikasi dan Informatika Pemprov.Kalimantan Timur05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKIHal 123

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2553 22/12/2<strong>01</strong>1 028/1548/SET-BKPL/2<strong>01</strong>1Kepala Badan Kesatuan Bangsa, Politik danPerlindungan Masyarakat Pemprov. Sumatera Barat05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2554 22/12/2<strong>01</strong>1 <strong>027</strong>/612 Kepala Dinas PU Prov. Sulawesi Tenggara 05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2555 22/12/2<strong>01</strong>1 -2556 22/12/2<strong>01</strong>1 1332/D-KUMKM/1.1/XII/2<strong>01</strong>12557 22/12/2<strong>01</strong>1 PHN.1-UM.<strong>01</strong>.<strong>01</strong>-233Kepala Balai Diklat PU Wilayah VII PalembangPusdiklat Setjend Kementerian PUKepala Dinas Koperasi dan Usaha Mikro Kecil danMenengah Pemprov. Sulawesi utaraSekretaris Badan Pembinaan Hukum NasionalKementerian Hukum dan HAM13/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>2456277702/<strong>01</strong>/12 08/<strong>03</strong>/12 PD0208696 Sudah pernah dikonversiSudah pernah dikonversi2558 22/12/2<strong>01</strong>1 - Sekretaris Daerah Pemkot Pekanbaru 02/<strong>01</strong>/12 17/<strong>01</strong>/12 02<strong>01</strong>245629772559 22/12/2<strong>01</strong>1 <strong>027</strong>/1638/Sekr Kepala Dinas Kehutanan Pemprov. Jawa BaratTidak ada sosialisasi perpres542560 22/12/2<strong>01</strong>1 9110/UN6.K2/TU/2<strong>01</strong>1 Pembantu Dekan II Filkom Univ. Padjajaran 05/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>245629702561 22/12/2<strong>01</strong>1 Dj.II.5/Kp.088/3537/2<strong>01</strong>1Direktur Pemberdayaan Wakaf Ditjend BimbinganMasyarakat Islam Kementerian Agama05/<strong>01</strong>/12 13/<strong>01</strong>/12 TIKI2562 22/12/2<strong>01</strong>1 HM.<strong>03</strong>.<strong>01</strong>.94.12.11.5156 Plh. Kepala Balai Besar POM di Bandung 05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2563 22/12/2<strong>01</strong>1 678/1.9/TVRI/2<strong>01</strong>1 Kapusdiklat LPP TVRI 05/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245628242564 22/12/2<strong>01</strong>1 DN.830/25/DPD/XII/2<strong>01</strong>1 Sekretaris Jenderal Dewan Perwakilan Daerah (DPD) 05/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245628222565 22/12/2<strong>01</strong>1 PL<strong>01</strong><strong>01</strong>-Aq/1040Kepala BBWS Serayu Opak Ditjen SDA KementerianPU05/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKI2566 23/12/2<strong>01</strong>1 686/SM/KU.02.<strong>01</strong>/12/2<strong>01</strong>1 Kabiro Umum Kementerian Perumahan Rakyat 05/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245629292567 23/12/2<strong>01</strong>1 800/404/2<strong>01</strong>1Kepala Dinas Pertanian Perkebunan dan KehutananKab. Tegal06/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625062568 23/12/2<strong>01</strong>1 800/575/Pusdiklatreg Kepala Pusdiklat Kemendagri Regional Makassar 06/<strong>01</strong>/12 25‐1‐‐2<strong>01</strong>2 02<strong>01</strong>24562569 23/12/2<strong>01</strong>1 -Kepala BBWS Pemali - Juana Ditjend SDAKementerian PU10/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>245627752570 23/12/2<strong>01</strong>1 800/3943/X/2<strong>01</strong>1 Sekretaris Daerah Pemkab Musi Banyuasin 06/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2571 23/12/2<strong>01</strong>1 09996/UN.41/TU/2<strong>01</strong>1 Rektor Univ. Negeri Manado 31/05/11 1611496510004Tidak ada sosialisasi perpres542572 23/12/2<strong>01</strong>1 640/86/ADM.PEMB/XII/2<strong>01</strong>1 Sekretaris Daerah Pemkab Luwu 05/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>24562844Hal 124

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2573 23/12/2<strong>01</strong>1 - LPMP Sulawesi Selatan 10/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245627872574 23/12/2<strong>01</strong>1 PD.<strong>01</strong>.<strong>01</strong>-Am/106/2<strong>01</strong>1Kabag TU BBWS Brantas Ditjend SDA KementerianPU05/<strong>01</strong>/12 12/<strong>01</strong>/12 TIKI2575 23/12/2<strong>01</strong>1 893.3/2420/122 Sekretaris Daerah Kota Magelang 10/<strong>01</strong>/12 17/<strong>01</strong>/12 02<strong>01</strong>245629802576 23/12/2<strong>01</strong>1 842.3/1642/PEG/DISHUTSekretaris Dinas Kehutanan Pemprov. KalimantanSelatan11/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245628382577 23/12/2<strong>01</strong>1 640/724/Dalminbang/2<strong>01</strong>1 Sekretaris Daerah Kota Payakumbuh 10/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629232578 23/12/2<strong>01</strong>1 TU.02.<strong>03</strong>/XII/244/2<strong>01</strong>12579 27/12/2<strong>01</strong>1 114/PL.0<strong>01</strong>/XII/AKPAR-2<strong>01</strong>1Kasubdit Pengendalian Vektor Ditjend PengendalianPenyakit dan Penyehatan Lingkungan (P2PL)Kementerian KesehatanDirektur Akademi Pariwisata Makassar KementerianPariwisata dan Ekonomi Kreatif11/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>2456252710/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245625282580 27/12/2<strong>01</strong>1 DP.04/11<strong>03</strong>3/SETJEN/XII/2<strong>01</strong>1 Sekretaris Jenderal DPR RI 12/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>245629592581 27/12/2<strong>01</strong>1 800/4432/411.202/2<strong>01</strong>1 Kepala Dinas Kesehatan Daerah Kab. Nganjuk 10/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625212582 27/12/2<strong>01</strong>1 007/257/DPU/Jwy/2<strong>01</strong>1 Kepala Dinas PU Kab. Jaya Wijaya 09/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629102583 27/12/2<strong>01</strong>1 2471/PPN-AMQ/TU.210/XII/2<strong>01</strong>12584 27/12/2<strong>01</strong>1 6291/DPB/PL.430.D3/XII/2<strong>01</strong>1Kepala Pelabuhan Perikanan Nusantara Ambon DitjendPerikanan Tangkap Kementerian KPDirektur Produksi Ditjend Perikanan BudidayaKementerian KP09/<strong>01</strong>/12 18/<strong>01</strong>/12 TIKI02/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629562585 27/12/2<strong>01</strong>1 B/875-<strong>01</strong>/05/<strong>01</strong> Komandan Lanud Husein Sastranegara 09/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245625242586 27/12/2<strong>01</strong>1 810/3788/DPU Kepala Dinas PU Kab. Bangli 10/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245627492587 27/12/2<strong>01</strong>1 800/3778/DPU Kepala Dinas PU Kab. Bangli 09/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629192588 27/12/2<strong>01</strong>1 600/1696/Bangda/2<strong>01</strong>1 Sekretaris Daerah Pemkab Tanah Laut 10/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKI2589 27/12/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/1.1/5430/2<strong>01</strong>1Direktur Politeknik Kesehatan Bandung KementerianKesehatan11/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245627252590 27/12/2<strong>01</strong>1 893.3/3162/BP-A Sekretaris Daerah Kab. Sanggau 09/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245629152591 27/12/2<strong>01</strong>1 PD.<strong>01</strong>.02/P2JN-MU/2<strong>01</strong>1/120 Kepala SNVT P2JN Prov. Maluku Utara 09/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>24562961Hal 125

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2592 27/12/2<strong>01</strong>1 Kd.13.32/1/KP.02.3/3183/2<strong>01</strong>1 Kepala Kantor Kota Malang Kementarian Agama 11/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245629282593 27/12/2<strong>01</strong>1 1967/BBRSBD.TU2/XII/2<strong>01</strong>12594 27/12/2<strong>01</strong>1 520-330/Distanak/XI/2<strong>01</strong>1Kepala Balai Besar Rehabilitasi Sosial Bina DaksaProf. DR. Soeharso Ditjend Rehabilitasi SosialKementerian SosialKepala Dinas Pertanian dan Peternakan Kab. BanggaiKepulauan10/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKI2595 27/12/2<strong>01</strong>1 Kd.21.10/1-c/KS.<strong>01</strong>.2/1946/2<strong>01</strong>1 Kepala Kantor Kab. Sinjai Kementerian Agama 14/<strong>03</strong>/12 2<strong>01</strong>28866213Tidak ada soialisasi perpres54Tidak melampirkanfotocopy sertifikat2596 27/12/2<strong>01</strong>1 - Sekretaris Daerah Pemkab Pasaman 10/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245628232597 27/12/2<strong>01</strong>1 896/SJ-DAG.6.5/SD/12/2<strong>01</strong>1Kepala Balai Diklat Penguji Mutu Barang PusdiklatPerdagangan10/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>245629412598 27/12/2<strong>01</strong>1 PL.04.<strong>01</strong>.3/1902/2<strong>01</strong>1Kepala Biro Keuangan dan Barang Milik NegaraSetjend Kementerian Kesehatan10/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245627322599 27/12/2<strong>01</strong>1 2<strong>01</strong>3/UN 37.3.1/TU/2<strong>01</strong>1 Sekretaris LPPM Univ. Negeri Semarang 11/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>245627742600 27/12/2<strong>01</strong>1 500.A2/342/AP/XII/2<strong>01</strong>1 Sekretaris Daerah Pemkab Agam 12/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>2456278226<strong>01</strong> 27/12/2<strong>01</strong>1 7063/H23.9/KS.00.<strong>01</strong>/2<strong>01</strong>1Ketua LPPM Univ.Jenderal Soedirman (Unsoed)Kemdiknas17/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245626472602 27/12/2<strong>01</strong>1 S-7708/WPJ.07/2<strong>01</strong>1Kepala Kantor Wilayah DJP Jakarta Khusus DitjendPajak Kementerian Keuangan10/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>2456295826<strong>03</strong> 27/12/2<strong>01</strong>1 PL.<strong>01</strong>.<strong>01</strong>/BWS.SII/4095Kepala BWS Sumatera II Ditjend SDA KementerianPU10/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>245628462604 27/12/2<strong>01</strong>1 050/3545/XII/2<strong>01</strong>1 Dir. RSUD Dokter Soeselo Pemkab Tegal 09/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245627272605 28/12/2<strong>01</strong>1 B/866/XII/2<strong>01</strong>1 Wadan Pusat Intelijen Mabes ADTidak ada sosialisasi perpres542606 28/12/2<strong>01</strong>1 S-51/IAPI-SUMUT.<strong>01</strong>/2<strong>01</strong>1 Ketua DPD IAPI Sumut 10/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625222607 28/12/2<strong>01</strong>1 020/0952/P-1/XII/2<strong>01</strong>1Kabag Perlengkapan Sekretariat Kab. KutaiKartanegaraTidak ada fotocopysertifikat, sertifkat masihberlaku2608 28/12/2<strong>01</strong>1 2109/DINSOS/XII/2<strong>01</strong>1 Kepala Dinas Sosial Pemprov. Sulawesi Barat 10/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625152609 29/12/2<strong>01</strong>1 2096/FTP-UGM/LK/2<strong>01</strong>1 Kepala Kantor Administrasi FTP Univ. Gajahmada 10/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKI2610 29/12/2<strong>01</strong>1 523.3/3566/2<strong>01</strong>1Kadinas Kelautan dan Perikanan Prov. SulawesiTenggara09/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>245627392611 29/12/2<strong>01</strong>1 800/649/411.4<strong>01</strong>/2<strong>01</strong>1 Direktur RSUD Nganjuk 10/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245628362612 29/12/2<strong>01</strong>1 1294/SJ.3/KOMINFO/12/2<strong>01</strong>1 Kabiro Keuangan Setjend Kominfo 12/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>24562911Hal 126

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2613 29/12/2<strong>01</strong>1 050/820/Bapp-Um/2<strong>01</strong>1 Kepala Bappeda dan Penanaman Modal Kab. Katingan Sudah pernah dikonversi2614 29/12/2<strong>01</strong>1 - Dedy Ridhovin Tidak ada surat permohonan2615 29/12/2<strong>01</strong>1 3146/UN29/LL/2<strong>01</strong>1 Rektor Universitas Haluoleo 10/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>245627<strong>01</strong>2616 29/12/2<strong>01</strong>1 15/S.Ket-BJ/XII/2<strong>01</strong>1 Kepala Bidang Bintek Jakon Dinas PU Prov. Maluku2617 29/12/2<strong>01</strong>1 690/285/PDAM/XII/2<strong>01</strong>12618 29/12/2<strong>01</strong>1 240/SP/PKP-BB/XII/2<strong>01</strong>1Direktur Utama PDAM Bandarmasih PemkotBanjarmasinKepala Satker Pengembangan Kawasan PermukimanBangka Belitung13/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>2456282612/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>24562783Tidak ada sosialisasi perpres542619 29/12/2<strong>01</strong>1 W.15.U/1773/UM.<strong>01</strong>.10/XII/2<strong>01</strong>1 Panitera/Sekretaris pengadilan Tinggi Banjarmasin 12/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>245627922620 30/12/2<strong>01</strong>1 S-3252/WPJ.02/KP.14/2<strong>01</strong>1Kepala KPP Pratama Tanjung Balai Karimun KanwilDJP Riau dan Kepulauan Riau Ditjend PajakKementerian KeuanganTidak ada sosialisasi perpres542621 30/12/2<strong>01</strong>1 142/DPU/XII/2<strong>01</strong>1 Kepala Dinas PU Pemkab Jeneponto 10/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245628452622 30/12/2<strong>01</strong>1 800/07/D/2/Diklat Kepala Bidang Teknis Badiklat Pemprov. Bengkulu 11/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>245629262623 30/12/2<strong>01</strong>1 910/PPNK/TU.110/XII/2<strong>01</strong>12624 30/12/2<strong>01</strong>1 050/065Kepala Pelabuhan Perikanan Nusantara KarangantuDirjend Perikanan Tangkap Kementerian Kelautan danPerikananAsisten Ekonomi, Pembangunan dan KesejahteraanSosial Setda Pemkot Tegal12/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>2456296312/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>245627362625 30/12/2<strong>01</strong>1 <strong>027</strong>/9<strong>01</strong>9/DPU Sekretaris Daerah Pemprov. Bengkulu 13/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>245627762626 30/12/2<strong>01</strong>1 UM.<strong>01</strong>.<strong>03</strong>-Sb/13592627 30/12/2<strong>01</strong>1 S-458/WBC.04/2<strong>01</strong>1Kepala Pusat Pengelolaan Barang Milik NegaraSetjend Kementerian PUPlh. Kepala Kanwil Khusus Kep. Riau Ditjend Bea danCukai Kementerian Keuangan2628 30/12/2<strong>01</strong>1 1362/SJ.3/KOMINFO/12/2<strong>01</strong>1 Kepala Biro Keuangan Setjend KOMINFO2629 30/12/2<strong>01</strong>1 600/BMP.SET/1593Sekretaris Dinas Bina Marga dan Pengairan PemkabKampar10/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKI10/<strong>01</strong>/12 16/<strong>01</strong>/12 TIKITidak ada surat keteranganaktif, Tidak ada sosialisasiperpes 54Tidak ada fotocopysertifikat2630 30/12/2<strong>01</strong>1 521.1/744/BKPP-PS/XII-2<strong>01</strong>1 Sekretaris Daerah Kab. Pesisir Selatan 12/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>24562821Hal 127

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2631 30/12/2<strong>01</strong>1 <strong>027</strong>/1341-II.1/BunSekretaris Dinas Perkebunan Pemprov. SumateraSelatan08/<strong>03</strong>/12 PD0208694Persyaratan tidak lengkap,Tidak melampirkanfotocopy sertifikat2632 30/12/2<strong>01</strong>1 B/4828/XII/2<strong>01</strong>1/Bareskrim Karorenmin Badan Reserse Kriminal Polri 10/<strong>01</strong>/12 17/<strong>01</strong>/12 TIKI2633 02/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/561/I.1/Nakertrans2634 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 05/BPSPL.<strong>01</strong>/I/2<strong>01</strong>22635 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 050/BPPDPM-TU/3592636 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>22637 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 2507/-084.212638 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 31/P2EM/XII/2<strong>01</strong>1Kepala Dinas Tenaga Kerja dan TransmmigrasiPemkab Barito TimurKPA Balai Pengelolaan Sumber Daya Pesisir dan Laut(BPSPL) DenpasarKepala Badan Perencanaan Pembangunan Daerah danPenanaman Modal Pemkab LinggaKepala ULP Barang/Jasa Sekretariat Daerah PemkabSubangKepala Sudin Pemadam Kebakaran danPenanggulangan Bencana Kota Administrasi JakartaSelatanKetua Pusat Penelitian Ekonomi dan Manajemen Univ.Tanjungpura17/<strong>01</strong>/12 02<strong>01</strong>2456300005/<strong>01</strong>/12 06‐1‐2<strong>01</strong>2 TIKI10/<strong>01</strong>/12 19/<strong>01</strong>/12 02<strong>01</strong>24562773Tidak ada sosialisasi perpres5417/<strong>01</strong>/12 02<strong>01</strong>24562998 Fotocopy sertifikat tidak ada11/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>2456294212/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629082639 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 055/4415/416-021/2<strong>01</strong>1 Sekretariat Daerah Pemkab Mojokerto 12/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629092640 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 B-221/Setneg/PPKK/KU/12/2<strong>01</strong>1Dir. Keuangan dan Umum Pusat Pengelolaan KomplekKemayoran Sekretariat NegaraTidak ada sosialisasi perpres542641 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 800/6679/AKP.Aset Sekretaris Daerah Prov. Bali 12/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629672642 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 S-241/WPJ.23/KP.<strong>01</strong>/2<strong>01</strong>1Kepala KPP Pratama Sleman Kanwil DIY DitjendPajak Kementerian KeuanganTidak ada Sosialisasiperpres 542643 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 B-3670/50-54/12/2<strong>01</strong>1 Pimpinan Komisi Pemberantasan Korupsi 12/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629182644 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 7687/DPT.0/TU.210.S1/XII/2<strong>01</strong>1 Sesditjen Perikanan Tangkap Kementerian KP 13/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245627062645 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 DM.<strong>01</strong>.04/II/2528/2<strong>01</strong>12646 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 W9-PR.<strong>01</strong>.02-7602647 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 UM.0<strong>01</strong>/3/9/DNG.DMI-2<strong>01</strong>1 &UM.0<strong>01</strong>/3/10/DNG.DMI-2<strong>01</strong>12648 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 A.3/523.800/463/XII/2<strong>01</strong>1Direktur Utama RS Jantung dan Pembuluh DarahHarapan Kita Ditjend Bina Pelayanan MedikKementerian KesehatanKepala Kanwil Jawa Tengah Kementarian Hukum danHAMKepala Distrik Navigasi Kelas I Dumai DitjendPerhubungan Laut Kementerian PerhubunganKepala Dinas Kelautan dan Perikanan Pemkab KutaiKartanegara17/<strong>01</strong>/12 02<strong>01</strong>2456298711/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>24562638Tidak ada fotocopysertifikat17/<strong>01</strong>/12 02<strong>01</strong>24562996 Tidak ada surat permohonan16/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>24562735Hal 128

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2649 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 800/21940/dikpora Dinas pendidikan pemuda dan olahraga Kab.kendal 16/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245627342650 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 DIKPORA/KPH/2<strong>01</strong>1 Dikpora Pemkab. Kepahing 16/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>245627382651 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 800/2739/Kepeg Setda Pemkab. Kayong UtaraTidak ada fotocopysertifikat2652 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 In.07/B. 1b/KP.02.<strong>03</strong>/ /2<strong>01</strong>1 Kementerian Agama IAIN Sumut 16/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629332653 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 246/UN33.9/PM/2<strong>01</strong>1 LPM Universitas Negeri Medan 17/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245627502654 04/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/ADEL.KEB/D.29.A Setda Pemkot. Pekanbaru 17/<strong>01</strong>/12 02<strong>01</strong>24562986 Persyaratan tidak lengkap2655 04/<strong>01</strong>/2<strong>01</strong>2 B/2423/XII/2<strong>01</strong>1 Komando Daerah Militer II/Sriwijaya TNI AD 13/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245626422656 04/<strong>01</strong>/2<strong>01</strong>2 UM<strong>01</strong><strong>03</strong>-KU/386Pusat Pembinaan Usaha dan Kelembagaan KementrianPU2657 04/<strong>01</strong>/2<strong>01</strong>2 5456/PL1.R/LK/2<strong>01</strong>1 Politeknik Negeri Bandung 10‐2‐2<strong>01</strong>2 02<strong>01</strong>245626912658 04/<strong>01</strong>/2<strong>01</strong>2 050/732/Bappeda Bappeda Pemkab. Klungkung 17/<strong>01</strong>/12 02<strong>01</strong>24562984Sudah pernah dikonversiTidak ada fotocopysertifikat2659 04/<strong>01</strong>/2<strong>01</strong>2 042/2779/XII/2<strong>01</strong>1 Dinas Kehutanan dan Perkebunan Pemkab. Bone 13/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245627<strong>03</strong>2660 04/<strong>01</strong>/2<strong>01</strong>2 893/30<strong>01</strong>/BKD Pemerintah Kabupaten Sleman 17/<strong>01</strong>/12 02<strong>01</strong>245629852661 04/<strong>01</strong>/2<strong>01</strong>2 800/BMP.SET/1575 Dinas Bina Marga dan Pengairan Pemkab. Kampar2662 04/<strong>01</strong>/2<strong>01</strong>2 188.45/920/426.3<strong>01</strong>/2<strong>01</strong>12663 04/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/002Badan Perencanaan Pembangunan Derah Pemkab.ProbolinggoBadan Penanggulangan Bencana Aceh PemerintahAceh13/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>24562747Tidak ada fotocopysertifikatTidak melampirkan suratpermohonan konversi17/<strong>01</strong>/12 02<strong>01</strong>24562997 Sertifikat masih berlaku2664 04/<strong>01</strong>/2<strong>01</strong>2 15/DST/PLP/XII/2<strong>01</strong>1 Diponegoro Procurement Smart Training 17/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245626492665 04/<strong>01</strong>/2<strong>01</strong>2 R/08/I/2<strong>01</strong>2 Dinas Pengadaan Mabes Angkatan Laut 13/<strong>01</strong>/12 29‐Maret‐2<strong>01</strong>2 PD02127682666 04/<strong>01</strong>/2<strong>01</strong>2 S.4<strong>03</strong>2/BPDAS.AK-1/2<strong>01</strong>1Balai Pengelolaan Das Agam Kuantan KementrianKehutanan12/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245627912667 04/<strong>01</strong>/2<strong>01</strong>2 522.0/412.b/XI/2<strong>01</strong>1 Dinas Kehutanan Pemkab. Gunung Mas 12/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>24562839Tidak ada alamatpengiriman2668 04/<strong>01</strong>/2<strong>01</strong>2Dinas Pengelolaan Sumber Daya Air PemprovSUMBAR, PadangSudah pernah diajukan/dikonversi2669 05/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>/330/UIPKITRINGKAL/2<strong>01</strong>2 PLN Kalimantan Proses Perbaikan/Koreksi Sertifikat2670 05/<strong>01</strong>/2<strong>01</strong>2 900/076.A/07/LU/2<strong>01</strong>1 Pemerintah kabupaten lampung Utara 16/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>24562737Hal 129

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2671 05/<strong>01</strong>/2<strong>01</strong>2 800/5588-DPP Dinas Pertanian dan Peternakan Kab. Tangerang 16/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245626432672 05/<strong>01</strong>/2<strong>01</strong>2 02/BP.1/PP.00.4/I/2<strong>01</strong>2 Sekretaris Badan Pengawas Mahkamah Agung RI 16/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245628422673 05/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>/C.CI/KP/2<strong>01</strong>2Dirjen Pendidikan Dasar Kementrian Pendidikan danKebudayaan2674 05/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/1638/sekr Dinas Kehutanan Pemprov JABAR16/<strong>01</strong>/12 20/<strong>01</strong>/12 02<strong>01</strong>24562847Tidak ada sosialisasi perpres542675 04/<strong>01</strong>/2<strong>01</strong>2 1312/SJ.3/KOMINFO/12/2<strong>01</strong>1 Biro Keuangan Sekjend KOMINFO 13/<strong>01</strong>/12 24/<strong>01</strong>/12 02<strong>01</strong>245629172676 06/<strong>01</strong>/2<strong>01</strong>2 522/02 Setda Pemkab. Bireuen 20/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625182677 06/<strong>01</strong>/2<strong>01</strong>2 Bdl.08/HM.00.3/005/2<strong>01</strong>2 Badiklat Keagamaan Banjarmasin 30/<strong>01</strong>/12 02<strong>01</strong>24562514Tidak ada fotocopysertifikat dan sertifikatmasih berlaku2678 06/<strong>01</strong>/2<strong>01</strong>2 188.45/920/426.3<strong>01</strong>/2<strong>01</strong>1 BAPPEDA Pemkab. Probolinggo Sudah pernah dikonversi2679 06/<strong>01</strong>/2<strong>01</strong>2 4982/UN35/KP/2<strong>01</strong>1 Univ. Negeri Padang 20/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625092680 06/<strong>01</strong>/2<strong>01</strong>2 B/440/VII/2<strong>01</strong>1 Direktorat Topografi Mabes AD 19/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625162681 06/<strong>01</strong>/2<strong>01</strong>2 W25.04.PL.<strong>03</strong>.022682 06/<strong>01</strong>/2<strong>01</strong>2 PD.<strong>01</strong>.07-KU/Bid.I/<strong>01</strong>Kementerian Hukum dan Hak Asasi Manusia RIKanwil. Sulawesi TenggaraPusat Pembinaan Usaha dan Kelembagaan KementrianPU17/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>2456291430/<strong>01</strong>/12 02<strong>01</strong>245625082683 06/<strong>01</strong>/2<strong>01</strong>2 Peg.800/11/DPU/2<strong>01</strong>2 Dinas PU Pemkab. Aceh Singkil 17/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625422684 06/<strong>01</strong>/2<strong>01</strong>2 821.27/3254/PEGUM Dinas Peternakan Pemprov. Jawa Barat 30/<strong>01</strong>/12 02<strong>01</strong>24562512Tidak melampirkanfotocopy sertifikatTidak ada sosialisasiperprers 542685 06/<strong>01</strong>/2<strong>01</strong>2 600/78/XII/2<strong>01</strong>1 Dinas PU Pemkab. Pulau Morotai 30/<strong>01</strong>/12 02<strong>01</strong>24562606 Sertifikat masih berlaku2686 06/<strong>01</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.02/Au/946 Balai Besar Wilayah Sungai Pompengan Jeneberang 17/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245627862687 06/<strong>01</strong>/2<strong>01</strong>2 Satker Pelaksanaan Jaringan Sumber Air Sumatera V 17/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>245627422688 06/<strong>01</strong>/2<strong>01</strong>2 522/1545-Umpeg/Dishut Dishut Pemprov. Kalimantan SelatanSudah pernah diajukan/dikonversi2689 06/<strong>01</strong>/2<strong>01</strong>2 005/PEN.1/1/2<strong>01</strong>2 Ditjen Pengembangan Ekspor Nasional Kemendag RI 19/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245629492690 06/<strong>01</strong>/2<strong>01</strong>2 200/840/2<strong>01</strong>1 Dinas Bina Marga Pemkab. Aceh Utara 30/<strong>01</strong>/12 02<strong>01</strong>24562639Tidak melampirkanfotocopy sertifikat2691 06/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>/DIISHUTBUN/I/2<strong>01</strong>2 Dishutbun Pemkab. Bulukumba 30/<strong>01</strong>/12 02<strong>01</strong>24562605 Sertifikat masih berlaku2692 06/<strong>01</strong>/2<strong>01</strong>2 Balai Wilayah Sungai Sumatera V 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>24562554Hal 130

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2693 06/<strong>01</strong>/2<strong>01</strong>2 B/29/I/2<strong>01</strong>2/Ditpoludara Ditpol Udara Badan Pemelihara Keamanan Polri 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625512694 06/<strong>01</strong>/2<strong>01</strong>2 63.513.906 Badan Pusat Statistik Prov. Kalimantan Selatan 20/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245626442695 06/<strong>01</strong>/2<strong>01</strong>2 B/14/I/2<strong>01</strong>2/Pusdik gasum Lembaga Pendidikan Polri Pusdik Gasum 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625742696 06/<strong>01</strong>/2<strong>01</strong>2 880/009/DINKES-A Dinkes Pemkab. Sanggau 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625552697 06/<strong>01</strong>/2<strong>01</strong>2 B.<strong>03</strong>/KP3K.5/I/2<strong>01</strong>2 Dirjen KP3K Kementerian Kelautan dan Perikanan 24/<strong>01</strong>/12 25/<strong>01</strong>/12 TIKI2698 06/<strong>01</strong>/2<strong>01</strong>2 600/DPU-SEK/352 Dinas PU Pemkab. Lingga 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625582699 06/<strong>01</strong>/2<strong>01</strong>2 UM.050/D1/I/2<strong>01</strong>2 Dinas Kelautan dan Perikanan Pemprov. Maluku Utara 18/<strong>01</strong>/12 18/<strong>01</strong>/12 TIKI2700 06/<strong>01</strong>/2<strong>01</strong>2 900/1266.5/Perindag.<strong>01</strong>-02/XI/2<strong>01</strong>1 Perindag Pemprov. Kalimantan Selatan 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>2456263627<strong>01</strong> 06/<strong>01</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.11-KP/345 Badan Pembinaan Konstruksi Kementerian PU 20/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>2456264<strong>027</strong>02 06/<strong>01</strong>/2<strong>01</strong>2 291-1.84 Setda Pemprov. DKI Jakarta 20/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>2456264527<strong>03</strong> 06/<strong>01</strong>/2<strong>01</strong>2 2471/PPN-AMQ/TU.210/XII/2<strong>01</strong>1 Pelabuhan Perikanan Nusantara Ambon 02/<strong>01</strong>/12 18/<strong>01</strong>/12 TIKI2704 06/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>1/Ro.4/M/KPBK/I/2<strong>01</strong>2 Kementerian Pariwisata dan Ekonomi Kreatif 30/06/12 02<strong>01</strong>24562641Tidak melampirkansosialisasi perpres54,SUDAH DIKONVERSI& SERTIFIKAT SUDAHDIKIRIM PADATGL. 8 32<strong>01</strong>2 VIA TIKI DENGANNMR AWB. 02<strong>01</strong>288663712705 06/<strong>01</strong>/2<strong>01</strong>2 S.1688/IV-K.16/Peg/2<strong>01</strong>1 Balai Konservasi SDA Jawa Tengah 20/<strong>01</strong>/12 25/<strong>01</strong>/12 02<strong>01</strong>245629162706 09/<strong>01</strong>/2<strong>01</strong>2 602,1/13/416-108/2<strong>01</strong>2 Dinas PU Pengairan Pemkab. Mojokerto 20/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>245625172707 09/<strong>01</strong>/2<strong>01</strong>2 Kw.13.1/5/Kp.02.3/51.1/2<strong>01</strong>1 Kanwil. Prov. Jawa Timur 25/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625522708 09/<strong>01</strong>/2<strong>01</strong>2 600/007/B-UM-BAPP BAPPEDA Pemprov. Kalimantan Timur 20/<strong>01</strong>/12 30/<strong>01</strong>/12 02<strong>01</strong>245626462709 09/<strong>01</strong>/2<strong>01</strong>2 S-<strong>01</strong>/WBC.11/BPIB/2<strong>01</strong>2 Balai Pengujian dan Identifikasi Barang Surabaya 19/<strong>01</strong>/12 27/<strong>01</strong>/12 02<strong>01</strong>245627042710 09/<strong>01</strong>/2<strong>01</strong>2 800/21/413.106/2<strong>01</strong>2Dinas Sosial Tenaga Kerja dan Transmigrasi Pemkab.Lamongan20/<strong>01</strong>/12 26/<strong>01</strong>/12 02<strong>01</strong>24562702Hal 131

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2711 09/<strong>01</strong>/2<strong>01</strong>2 S.1/PJLKKHL-5/2<strong>01</strong>2Direktorat pemanfaatan Jasa Lingkungan KawasanKonservasi dan Hutan Lindung KementerianKehutanan24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245626742712 09/<strong>01</strong>/2<strong>01</strong>2 050/0023 Setda Pemkab. Jepara 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625572713 09/<strong>01</strong>/2<strong>01</strong>2 800/126/04/2<strong>01</strong>1 Setda Pemkab. Sragen 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625412714 09/<strong>01</strong>/2<strong>01</strong>2 B/29/I/2<strong>01</strong>2 Panglima Kodam XVII/Cendrawasih 24/<strong>01</strong>/12 Proses2715 09/<strong>01</strong>/2<strong>01</strong>2 W31.PL.02.<strong>03</strong>-0<strong>01</strong>4Kepala Kantor Wilayah Gorontalo KementerianHukum dan HAM25/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>245625312716 09/<strong>01</strong>/2<strong>01</strong>2 602/007/V/PSDA Kepala Dinas Pengelolaan SDA Prov. Sumatera Utara 25/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625532717 09/<strong>01</strong>/2<strong>01</strong>2 265/SES/XII/2<strong>01</strong>1 Sekretaris Jenderal Komisi Nasional HAM <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245626482718 09/<strong>01</strong>/2<strong>01</strong>2 0<strong>03</strong>/S.0.3.1/I/2<strong>01</strong>2 Sekretaris Jenderal Komisi Nasional HAM <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>24562648Tidak ada alamatpengiriman sertifikatTidak melempirkansosialisasi perpres 54Tidak melampirkansosialisasi perpres 542719 09/<strong>01</strong>/2<strong>01</strong>2 523/DKP-Set/<strong>01</strong>9 Kadis Kelautan dan Perikanan Kab. Bintan 24/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625592720 09/<strong>01</strong>/2<strong>01</strong>2 007/KTL/I/2<strong>01</strong>22721 10/<strong>01</strong>/2<strong>01</strong>2 S-34/Lurah Tanah Lemo Kec. Bontobahari PemkabBulukumbaKepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe Madya Pabean Jambi Kanwil SumselKementerian Keuangan27/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>24562668Tidak ada keteranganmegikuti pelatihan perpres542722 10/<strong>01</strong>/2<strong>01</strong>2 028/31/UMUM Sekretaris Daerah Pemkab Bulukumba 27/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>245626762723 10/<strong>01</strong>/2<strong>01</strong>2 0<strong>01</strong>/PUSPIN/I/2<strong>01</strong>2Direktur Program Lembaga Pusat Pengkajian InformasiNasional30/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>245625452724 10/<strong>01</strong>/2<strong>01</strong>2 873.2/A.2/5485/2<strong>01</strong>1 Kepala Dinas Pendidikan 08‐3‐2<strong>01</strong>2 02<strong>01</strong>288662<strong>01</strong> Sudah pernah dikonversi2725 10/<strong>01</strong>/2<strong>01</strong>2 UM.0<strong>03</strong>/4/13/PLP.JKT-112726 10/<strong>01</strong>/2<strong>01</strong>2 PL.02.06-BBPJN VI /XII/1829Kepala Pangkalan Penjagaan Laut dan Pantai Kelas ITanjung Priok Ditjend Perhubungan KementerianPerhubunganKepala Balai Besar Pelaksanaan Jalan Nasional VI ,Makassar Ditjen Bina marga kementerian PekerjaanUmum12/<strong>03</strong>/12 02<strong>01</strong>2886638731/<strong>01</strong>/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>24562680Tidak ada keteranganmegikuti pelatihan perpres542727 10/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>7/BP3TI.1/Kominfo/1/ 2<strong>01</strong>2Kepala Balai Penyedia Dan Pengelola PembiayaanTelekomunikasi dan Informatika DitjenPenyelenggaraan Pos Dan Informatika Kominfo RI12/<strong>03</strong>/2<strong>01</strong>2; 27‐3‐2<strong>01</strong>22<strong>01</strong>28866389 danPD0212613 (krmulang)Sertifikat masih berlaku,Tidak ada sosialisasi perpres542728 10/<strong>01</strong>/2<strong>01</strong>2 800/DKPPID/PHWT/20/I/2<strong>01</strong>2Kabid Perdagangan Dan Investasi Daerah DinasKoperasi Perindustrian Pemkab Pahuwato30/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>24562658Hal 132

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2729 10/<strong>01</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>03</strong>-bl.ie/14Kepala Sub Bagian Tata Usaha Direktorat BinaPelaksanaan Wilayah I Ditjen Bina Marga KementerianPU30/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>245626652730 10/<strong>01</strong>/2<strong>01</strong>2 890/PU-UPTJKSDM/15 An. Kepala Dinas Pekerjaan Umum Provinsi Riau 30/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>245625442731 10/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/<strong>01</strong>67/BPP/I/2<strong>01</strong>22732 10/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/0020/P3 Luh2733 10/<strong>01</strong>/2<strong>01</strong>2 090/06/Um/2<strong>01</strong>12734 10/<strong>01</strong>/2<strong>01</strong>2 Um.002/I/16/OP.TDK.122735 10/<strong>01</strong>/2<strong>01</strong>2 050/18092736 11/<strong>01</strong>/2<strong>01</strong>2 522/17/I/2<strong>01</strong>2/Dishutbun2737 11/<strong>01</strong>/2<strong>01</strong>2 523/1022/ 2<strong>01</strong>12738 11/<strong>01</strong>/2<strong>01</strong>2 S-07/WBC.16/KPP.09/2<strong>01</strong>2Kepala Badan Penelitian Dan PengembanganPemerintah Provinsi Sumatera UtaraKepala Dinas Pertanian Perkebunan dan PerhutananPemerintah Kabupaten BangliKepala Dinas Perkebunan Pemerintah KabupatenKotawaringin TimurKepala Kantor Otoritas Pelabuhan Tanjung PriokDirektorat Jenderal Perhubungan Laut KementerianPerhubunganPlt. Sekretaris Daerah Kabupaten Kebumen SekretariatDaerah Pemkab KebumenKepala Dinas Kehutanan dan Perkebunan PemerintahKabupaten MamujuAn. Kepala Dinas Bina Marga dan Cipta KaryaPemkab PidiePj. Kepala Kantor, Kantor Pengawasan Dan PelayananBea dan Cukai Tipe A3 Jayapura , Kanwil Maluku,Papua dan Papua Barat , Ditjen Bea dan Cukaikementerian Keuangan RI30/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456254330/<strong>01</strong>/12 <strong>01</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>2456267430/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456267330/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456267527/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456254627/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456253026/<strong>01</strong>/12 02‐2‐12 02<strong>01</strong>2456267227/<strong>01</strong>/12 02‐2‐12 02<strong>01</strong>2456254<strong>027</strong>39 11/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/002/437.14/2<strong>01</strong>1 A.n. Sekretaris Daerah Pemerintah Kabupaten Gresik 27/<strong>01</strong>/12 <strong>03</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>245625372740 11/<strong>01</strong>/2<strong>01</strong>2 800/81 Kepala Bappeda Pemkot Medan 12/<strong>03</strong>/12Tidak melampirkanfotocopy sertifikat2741 11/<strong>01</strong>/2<strong>01</strong>2 <strong>03</strong>6/PL29/I/2<strong>01</strong>2 Direktur Politeknik Negeri Batam 30/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>245625482742 11/<strong>01</strong>/2<strong>01</strong>2 045.2/022743 11/<strong>01</strong>/2<strong>01</strong>2 SM.304/I/I/UPP-Pmk-112744 11/<strong>01</strong>/2<strong>01</strong>2 SP-40/WPB.07/KP.0410/ 2<strong>01</strong>22745 11/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/06.1/ Ekbang.B/ 2<strong>01</strong>2Kepala Balai Pelaksana Teknis Bina Marga WilayahTegal Dinas Bina Marga pemprov Jawa TengahKepala Kantor UPP Pamanukan Ditjen PerhubunganLaut Kementerian PerhubunganKepala Kantor Pelayanan Perbendaharaan NegaraLubuk Linggau Kanwil Provinsi Sumatera SelatanDitjen Perbendaharaan Kemenkeu RISekretaris Daerah Kota Pontianak Sekretariat DaerahKota Pontianak Pemerintah Kota Pontianak30/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456254927/<strong>01</strong>/12 <strong>03</strong>‐2‐2<strong>01</strong>2 02<strong>01</strong>2456253227/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456255<strong>01</strong>2/<strong>03</strong>/12 PD0208692 Sertifikat masih berlakuHal 133

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2746 11/<strong>01</strong>/2<strong>01</strong>2 441/53/430.10.2/2<strong>01</strong>2 Plt. Kepala Dinas Kesehatan Pemkab Bondowoso 27/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>245625392747 11/<strong>01</strong>/2<strong>01</strong>2 S.116/BP2HPXII-1/2<strong>01</strong>1Kepala Balai Pemantauan Pemanfaatan Hutan ProduksiWilayah XII Ditjend Bina Usaha KehutananKementerian Kehutanan<strong>01</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627192748 11/<strong>01</strong>/2<strong>01</strong>2 UM <strong>03</strong> 02/Ab-XII/399 Direktur Bina Penatagunaan Sumber Daya Air 09/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>2294676<strong>027</strong>49 11/<strong>01</strong>/2<strong>01</strong>2 S-9/SJ.7/2<strong>01</strong>2 Kabiro Perlengkapan Setjend Kementerian Keuangan <strong>01</strong>/02/12 08‐2‐2<strong>01</strong>2 02<strong>01</strong>245626812750 11/<strong>01</strong>/2<strong>01</strong>2 800/2Kabalai Pemberdayaan dan Pengawasan JasaKonstruksi Dinciptakaru Prov. Jawa Tengah<strong>01</strong>/02/12 08‐2‐2<strong>01</strong>2 02<strong>01</strong>245627122751 11/<strong>01</strong>/2<strong>01</strong>2 D.022/KP.107/BPPP.P-12Kepala Balai Diklat Penerbangan Palembang BadanPengembangan SDM Perhubungan Kem. Perhubungan12/<strong>03</strong>/12 PD0208655Tidak melampirkan suratketerangan aktif2752 11/<strong>01</strong>/2<strong>01</strong>2 050.89/Bapemb/I/2<strong>01</strong>2 Sekretaris Daerah Kota Padang <strong>01</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627162753 11/<strong>01</strong>/2<strong>01</strong>2 602/DBM-PE/140/2<strong>01</strong>2 Kepala Dinas Bina Marga Prov. Sumatera Utara <strong>01</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>245626972754 11/<strong>01</strong>/2<strong>01</strong>2 912/21-Admpemb/2<strong>01</strong>2 Sekretaris Daerah Kab. Lebak <strong>01</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>245627432755 11/<strong>01</strong>/2<strong>01</strong>2 UM.002/043/I/ATKP.SBY-122756 12/<strong>01</strong>/2<strong>01</strong>2 S-190/WPJ.32/KP.08/2<strong>01</strong>22757 12/<strong>01</strong>/2<strong>01</strong>2 UM.002/19/13/PPSDMPD-2<strong>01</strong>22758 12/<strong>01</strong>/2<strong>01</strong>2 S-20/BL.<strong>01</strong>/UP.6/2<strong>01</strong>22759 12/<strong>01</strong>/2<strong>01</strong>2 800/448/DPU.BM/OKU.T/2<strong>01</strong>1Direktur Akademi Teknik dan KeselamatanPenerbangan Surabaya Badan Pengembangan SDMPerhubungan Kementerian PerhubunganKepala KPP Pratama Sukoharjo Kanwil DJP JawaTengah II Ditjend Pajak Kementerian KeuanganKapus Pengembangan dan Perhubungan Darat BPSDMPerhubungan Kem. PerhubunganSekretaris Badan Pengawas Pasar Modal dan LembagaKeuangan, Kementerian KeuanganKepala Dinas PU Bina Marga Kab. Ogan KomeringUlu Timur<strong>01</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>2456267726/<strong>01</strong>/12 02‐2‐2<strong>01</strong>2 02<strong>01</strong>2456254712/<strong>03</strong>/12 PD0208656<strong>01</strong>/02/12 15‐2‐2<strong>01</strong>2 02<strong>01</strong>22946765Tidak melampirkanpelatihan perpres 54 danfotocopy sertifikat PBJ12/<strong>03</strong>/12 PD0208653 sertifikat masih berlaku2760 12/<strong>01</strong>/2<strong>01</strong>2 PD.<strong>01</strong>.04.PJN.WIL-1/RIAU/2<strong>01</strong>2/04 Ka. Satker PJ Wilayah I Prov. Riau <strong>01</strong>/02/12 15‐2‐2<strong>01</strong>2 02<strong>01</strong>229467712761 12/<strong>01</strong>/2<strong>01</strong>2 050/14/Sekr.1/22/2<strong>01</strong>2 Kadinas Pendidikan Prov. Sumatera Utara <strong>01</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>245626792762 12/<strong>01</strong>/2<strong>01</strong>2 - Heru Purwanto 12/<strong>03</strong>/12 PD0208654tidak melampirkan sertifikatpelatihan perpres 54Hal 134

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2763 12/<strong>01</strong>/2<strong>01</strong>2 050/04/BP3MD-IV/2<strong>01</strong>2Kepala Badan Perencanaan Pembangunan danPenanaman Modal Daerah (BP3MD) Pemkab BangkaSelatan<strong>01</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627182764 12/<strong>01</strong>/2<strong>01</strong>2 600/420/Bang-I/12/2<strong>01</strong>2 PLT. Sekretaris Daerah Pemkab Berau 14/<strong>03</strong>/12 PD0208760Tidak melampirkanfotocopy sertifikat2765 12/<strong>01</strong>/2<strong>01</strong>2 TU.13/LLASDP/I/2<strong>01</strong>22766 13/<strong>01</strong>/2<strong>01</strong>2 800/88/DISKES/2<strong>01</strong>2Kasubbag TU Direktorat Lalu Lintas dan AngkutanSungai, Danau dan Penyebrangan Ditjend PerhubunganDarat, Kem. PerhubunganKepala Dinas Kesehatan Pemerintah Kabupaten BaritoUtara<strong>01</strong>/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>22946757<strong>01</strong>/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467732767 13/<strong>01</strong>/2<strong>01</strong>2 0<strong>01</strong>/RL/I/2<strong>01</strong>2 Pemohon Ruben Lawa 12/<strong>03</strong>/12 PD0208651tidak melampirkan sertifikatpelatihan perpres 542768 13/<strong>01</strong>/2<strong>01</strong>2 W4-A/143/OT.<strong>01</strong>.1/I/2<strong>01</strong>2 Ketua Pengadilan Tinggi Agama Pekanbaru <strong>01</strong>/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>229467852769 13/<strong>01</strong>/2<strong>01</strong>2 B/07/I/2<strong>01</strong>2/ RumkitKepala Rumah Sakit Bhayangkara PalembangKepolisian Negara RI12/<strong>03</strong>/12 PD0208689tidak melampirkan sertifikatpelatihan perpres 542770 13/<strong>01</strong>/2<strong>01</strong>2 139/-084.3Kepala Dinas Perindustrian Dan Energi Pemprov DKIJakarta<strong>01</strong>/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>229467692771 13/<strong>01</strong>/2<strong>01</strong>2 800/046-Mutasi & Bangrir Kepala BKPP Pemkot Bogor <strong>01</strong>/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294675<strong>027</strong>72 13/<strong>01</strong>/2<strong>01</strong>2 028/0043-PK Sekretaris Daerah Pemerintah Kota Cirebon <strong>01</strong>/02/12 15‐2‐2<strong>01</strong>2 02<strong>01</strong>229467642773 13/<strong>01</strong>/2<strong>01</strong>2 Um.<strong>01</strong>.<strong>01</strong>-SS4/04Kepala Bagian Tata Usaha Pusat Kajian Strategi(PUSTRA) Setjen kementerian PU<strong>01</strong>/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>245626832774 13/<strong>01</strong>/2<strong>01</strong>2 07/PEMB-SDA/I/2<strong>01</strong>2 Sekretaris Daerah Pemerintah Kabupaten Karimun 02/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467992775 13/<strong>01</strong>/2<strong>01</strong>2 050/47/05/ 2<strong>01</strong>2 Sekretaris Daerah Pemkab Magelang <strong>03</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>245626792776 13/<strong>01</strong>/2<strong>01</strong>2 050/3545/XII/2<strong>01</strong>1 Pil. Direktur RSUD Dokter Soeselo Pemkab. Tegal 12/<strong>03</strong>/12 PD0208690 Sudah pernah dikonversi2777 13/<strong>01</strong>/2<strong>01</strong>2 893.3/942/B-Tek/2<strong>01</strong>1 Kabid Diklat Teknis Badiklat Pemprov Sumatera Barat 02/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627262778 13/<strong>01</strong>/2<strong>01</strong>2 0<strong>03</strong>24/IT2/LL/2<strong>01</strong>2 Rektor Institut Teknologi Sepuluh <strong>No</strong>pember Sertifikat masih berlaku2779 13/<strong>01</strong>/2<strong>01</strong>2 070/BPIPBPJK/0<strong>03</strong>/2<strong>01</strong>1Kepala Balai PIPBPJK Dinas PU - ESDM PemerintahProvinsi DIY02/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>245626822780 13/<strong>01</strong>/2<strong>01</strong>2 PL.<strong>01</strong>.<strong>01</strong>/1.1/5431/2<strong>01</strong>1 Direktur Politeknik Kesehatan Bandung 02/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>245626852781 13/<strong>01</strong>/2<strong>01</strong>2 S.38/Set-4/2<strong>01</strong>2Sekretaris Badan SDM Kehutanan Badan PenyuluhanDan Pengembangan Kementerian Kehutanan02/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>24562696Hal 135

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2782 13/<strong>01</strong>/2<strong>01</strong>2 15/UN21/LL/2<strong>01</strong>2 Pembantu Rektor II Universitas Jambi 02/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>2456270<strong>027</strong>83 13/<strong>01</strong>/2<strong>01</strong>2 31.000.<strong>01</strong>5 Kepala Badan Pusat Statistik Provinsi DKI Jakarta 02/02/12 08‐2‐2<strong>01</strong>2 02<strong>01</strong>245627142784 13/<strong>01</strong>/2<strong>01</strong>2 Pd <strong>01</strong><strong>01</strong>-Sl.7/19Kepala Balai Diklat Wilayah VII Palembang, PusdiklatSetjen Kementerian PU02/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627242785 13/<strong>01</strong>/2<strong>01</strong>2 S-20/PK.1/ 2<strong>01</strong>2 Sekretaris Ditjen PK Kementerian Keuangan RI 02/02/12 08‐2‐2<strong>01</strong>2 02<strong>01</strong>245626072786 13/<strong>01</strong>/2<strong>01</strong>2 893.3/5642 Sekretaris Daerah Pemkot Semarang 02/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627232787 16/<strong>01</strong>/2<strong>01</strong>2 050/6/7/2<strong>01</strong>1 Sekretaris Dinas Perhubungan Pemprov. Maluku 02/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>229467742788 16/<strong>01</strong>/2<strong>01</strong>2 833/1523/Kep.Um Kepala Dinas Bina Marga Prov. Jawa Barat 15/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>229465842789 16/<strong>01</strong>/2<strong>01</strong>2 524/<strong>03</strong>19/A2.Nak-KeswandaKepala Dinas Peternakan dan Kesehatan Hewan Prov.Sulawesi Tengah12/<strong>03</strong>/12 PD0208691tidak melampirkan sertifikatpelatihan perpres 542790 16/<strong>01</strong>/2<strong>01</strong>2 18/078.4 Camat Kemayoran 02/02/12 08‐2‐2<strong>01</strong>2 02<strong>01</strong>245627132791 16/<strong>01</strong>/2<strong>01</strong>2 07/DPP/I/2<strong>01</strong>2Kepala Dinas Perindustrian dan Perdagangan Prov.Kep. Riau27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946683tidak melampirkan sertifikatpelatihan perpres 542792 16/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/19/404.6.3/2<strong>01</strong>2 Kepala Badan Lingkungan Hidup Kab. Sidoarjo 02/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467542793 16/<strong>01</strong>/2<strong>01</strong>2 952/Sesprov.<strong>01</strong>3/XII/2<strong>01</strong>1 Sekretaris Komisi Pemilihan Umum Prov. DIY 02/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467552794 16/<strong>01</strong>/2<strong>01</strong>2 523/14/D.KP/2<strong>01</strong>2Kepala Dinas Kelautan dan Perikanan Kab. OganKomering Ilir02/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467562795 16/<strong>01</strong>/2<strong>01</strong>2 PD.<strong>03</strong>.<strong>01</strong>/At/485 Kepala BBWS Cimanuk - Cisanggarung 02/02/12 10‐2‐2<strong>01</strong>2 02<strong>01</strong>245626872796 16/<strong>01</strong>/2<strong>01</strong>2 S-81/WBC.09/2<strong>01</strong>22797 16/<strong>01</strong>/2<strong>01</strong>2 66/1.795.12Kepala Kantor DJBC Jawa Tengah dan DIY DitjendBea dan Cukai Kementerian KeuanganKepala Suku Dinas Perindustrian dan Energi KotaAdministrasi Jakarta Pusat27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946685tidak ada fotocopy sertifikatPBJ27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946682 sertifikat masih berlaku2798 16/<strong>01</strong>/2<strong>01</strong>2 15/DBM-Sekrt/I/2<strong>01</strong>2 Sekretaris Dinas Bina Marga Pemkot Banjarmasin 27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946568Tidak ada sosialisasi perpres542799 17/<strong>01</strong>/2<strong>01</strong>2 W1.Ea.DL.<strong>03</strong>.<strong>01</strong>-20Kepala Lembaga Pemasyarakatan Klas II A BandaAceh Kanwil Aceh Kementerian Hukum dan HAM RI13/<strong>03</strong>/12 PD0208613Tidak ada sosialisasi perpres542800 17/<strong>01</strong>/2<strong>01</strong>2 893/<strong>03</strong>1/2<strong>01</strong>2 Kepala Dinas Peternakan Pemkab Gunung Kidul <strong>03</strong>/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>2456269928<strong>01</strong> 17/<strong>01</strong>/2<strong>01</strong>2 29/SEKR/I-2<strong>01</strong>2U.b. Asisten Sekda Bidang Adm. Umum SekretariatDaerah Pemkab Minahasa Selatan13/<strong>03</strong>/12 PD0208614Sertifikat masih berlaku.Tidak ada sosialisasi perpres54Hal 136

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2802 17/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>18/UN10.2/KP/2<strong>01</strong>2Pembantu Dekan II Fakultas Ekonomi dan BisnisUniversitas Brawijaya14‐Feb‐2<strong>01</strong>2 14‐2‐2<strong>01</strong>2 02<strong>01</strong>2294680028<strong>03</strong> 17/<strong>01</strong>/2<strong>01</strong>2 B/119/I/2<strong>01</strong>2 Kepala Kepolisian Daerah Nusa Tenggara TimurTidak ada sosialisasi perpres542804 17/<strong>01</strong>/2<strong>01</strong>2 <strong>03</strong>37/B.04/<strong>01</strong>/2<strong>01</strong>2Kepala Biro Perencanaan Organisasi dan Tata LaksanaKementerian PPN Bappenas09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467512805 17/<strong>01</strong>/2<strong>01</strong>2 S-08/WPJ.22/PPK.<strong>01</strong>/2<strong>01</strong>2Kepala Kantor Pelayanan Penuyuluhan dan KonsultasiPerpajakan Majalengka Kanwil DJP Jawa Barat II ,Ditjen Pajak Kemenkeu RI08/<strong>03</strong>/12 02<strong>01</strong>28866337Tidak ada sosialisasi perpres542806 17/<strong>01</strong>/2<strong>01</strong>2 825/H3.5/LK/2<strong>01</strong>2 Direktur Sumber Daya Universitas Airlangga 09/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>229467702807 17/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/I/000<strong>03</strong>6/Penda2808 17/<strong>01</strong>/2<strong>01</strong>2 S-458/ WBC.04/ 2<strong>01</strong>12809 17/<strong>01</strong>/2<strong>01</strong>2 SEK.4.PL.02.<strong>03</strong>-192810 17/<strong>01</strong>/2<strong>01</strong>2 Sti.34/II/Kp.<strong>01</strong>.2/004/ 2<strong>01</strong>2Kepala Dinas Pendapatan Daerah Pemprov SumateraSelatanPlh. Kepala Kantor Wilayah Khusus Kepulauan RiauDitjen Bea dan Cukai kemenkeu RIKepala Biro Perlengkapan Setjen kementerian Hukumdan HAM RIKetua Sekolah Tinggi Agama Islam NegeriKementerian Agama09/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>2294676105‐3‐2<strong>01</strong>2 02<strong>01</strong>28866271 Sudah pernah dikonversi14/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>2294654427/<strong>03</strong>/12 27‐3‐2<strong>01</strong>2 PD0212678Tidak ada fotocopysertifikat2811 17/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>8/Sekr/ 2<strong>01</strong>2 Plt. Sekretaris Ditjen pemerintah Umum Kemendagri 09/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467672812 17/<strong>01</strong>/2<strong>01</strong>2 S-16/WPJ.20/KP.<strong>03</strong>/2<strong>01</strong>2Kepala Kantor Pelayanan Pajak Pratama PulogadungKanwil DJP Jakarta Timur Ditjen Pajak Kemen Keu RI09/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467582813 17/<strong>01</strong>/2<strong>01</strong>2 050/002<strong>01</strong>/ Pemb Sekretaris Daerah Pemkab Banjar 08/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467722814 17/<strong>01</strong>/2<strong>01</strong>2 00021/PL/<strong>01</strong>/2<strong>01</strong>2/ULP Kepala Unit Layanan Pengadaan Setjen Kemenlu RI 09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467272815 17/<strong>01</strong>/2<strong>01</strong>2 S-20/BL.<strong>01</strong>/UP.6/2<strong>01</strong>22816 17/<strong>01</strong>/2<strong>01</strong>2 Sek.3-UM.07.05.072817 17/<strong>01</strong>/2<strong>01</strong>2 151/BNND/XII/2<strong>01</strong>12818 17/<strong>01</strong>/2<strong>01</strong>2 190/DPU/IX/2<strong>01</strong>12819 17/<strong>01</strong>/2<strong>01</strong>2 045.2/52/IV/2<strong>01</strong>12820 17/<strong>01</strong>/2<strong>01</strong>2 5452.108/02/DPUP/M/I/2<strong>01</strong>2Sekretaris Badan Pengawas Ps. Modal Dan LembagaKeuangan Kementerian Keuangan RIKepala Biro Umum Sekretariat Jenderal OmbudsmanRIKepala Badan Narkotika Nasional Provinsi SulawesiTenggaraPlt. Kepala Dinas Pekerjaan Umum Pemkab KepulauanTalaudAsisten Bidang Perekonomian Dan PembangunanSekretariat Daerah Pemprov Kepulauan BangkaBelitungKepala Dinas Pekerjaan Umum Dan PerumahanPemkab Mamasa05‐3‐2<strong>01</strong>2 02<strong>01</strong>28866272 Sudah pernah dikonversi09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294673409/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>2456268609/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294663708/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>2456268915/<strong>03</strong>/12 PD0212579Hal 137

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2821 17/<strong>01</strong>/2<strong>01</strong>2 028/093/Dinkes Kepala Dinas Kesehatan Pemkab Karangasem 27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946670 Sudah Lulus Ujian th.2<strong>01</strong>22822 17/<strong>01</strong>/2<strong>01</strong>2 600/94/DPU/2<strong>01</strong>2Kepala Dinas Pekerjaan Umum Pemkab LombokTengah<strong>03</strong>/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>245626842823 17/<strong>01</strong>/2<strong>01</strong>2 42/UM-RT/I/2<strong>01</strong>2 Kepala Biro Umum Kementerian Sosial RI <strong>03</strong>/02/12 08‐2‐2<strong>01</strong>2 02<strong>01</strong>245627112824 17/<strong>01</strong>/2<strong>01</strong>2 02/I/ULP/2<strong>01</strong>2 Sekretaris Daerah Pemkot Prabumulih 08/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467422825 17/<strong>01</strong>/2<strong>01</strong>2 425/05/ADPUb. Asisten Adm.Perekonomian dan PembangunanSekretariat Daerah Pemkab Lombok Tengah17/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229465422826 17/<strong>01</strong>/2<strong>01</strong>2 912/<strong>01</strong><strong>03</strong>/Ekbang-2<strong>01</strong>2 Sekretaris Daerah Pemerintah Kota Pariaman 08/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>229467332827 17/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>/LPPN/I/2<strong>01</strong>22828 17/<strong>01</strong>/2<strong>01</strong>2 523/62/I/DKP/2<strong>01</strong>22829 17/<strong>01</strong>/2<strong>01</strong>2 S-34/WBC.05/KPP.MP.02/2<strong>01</strong>2Direktur Program Lembaga PengembanganPengetahuan NusantaraKepala Dinas Kelautan dan Perikanan PemprovSulawesi BaratKepala Kantor PP Bea dan Cukai Tipe Madya PabeanB Jambi Kanwil Sumatera Bag Selatan Ditjen Bea danCukai kemen Keu RI08/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294675313/<strong>03</strong>/12 PD0208612 tidak ada fotocopy sertifikat13/<strong>03</strong>/12 PD0208611Tidak ada SosialisasiPerpres 542830 17/<strong>01</strong>/2<strong>01</strong>2 440.441.7/513/I/2<strong>01</strong>2 Kepala Dinas Kesehatan Pemprov Sumatera Utara 08/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466232831 17/<strong>01</strong>/2<strong>01</strong>2 65/DINSOS/I/2<strong>01</strong>2 Kepala Dinas Sosial Pemprov Sulawesi Barat 08‐3‐2<strong>01</strong>2 PD0208719 Sudah Pernah dikonversi2832 17/<strong>01</strong>/2<strong>01</strong>2 S-5/WBC.10/2<strong>01</strong>2Kepala Kantor Wilayah DJBC Jawa Timur I Ditjen Bea& Cukai kemen Keu RI27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946681Tidak ada SosialisasiPerpres no.54 Tahun 2<strong>01</strong>0,Sudah Pernah Konversi2833 17/<strong>01</strong>/2<strong>01</strong>2 800/0062/433.023/2<strong>01</strong>2 Sekretaris Daerah Pemkab Bangkalan 08/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>245626922834 18/<strong>01</strong>/2<strong>01</strong>2 - Dir. RS Daerah Kab. Landak <strong>03</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627452835 18/<strong>01</strong>/2<strong>01</strong>2 OR.<strong>01</strong>.02/BWS-Sul.II/<strong>01</strong> Kepala BWS Sulawesi II <strong>03</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>245627152836 18/<strong>01</strong>/2<strong>01</strong>2 S-13/WPJ.04/KP.10<strong>01</strong>/2<strong>01</strong>22837 18/<strong>01</strong>/2<strong>01</strong>2 PD.<strong>01</strong>.07-CK/24Kepala KPP Pratama Jakarta Pasar Minggu KanwilDJP Jakarta Selatan Ditjend Pajak KementerianKeuanganDirektur Pengembangan Permukiman, Ditjen CiptaKarya Kem. PU<strong>03</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>24562722<strong>03</strong>/02/12 08‐2‐2<strong>01</strong>2 02<strong>01</strong>245627102838 18/<strong>01</strong>/2<strong>01</strong>2 B/67/I/2<strong>01</strong>2 Aslog Kodam VI/Mulawarman <strong>03</strong>/02/12 10‐2‐2<strong>01</strong>2 02<strong>01</strong>24562690Hal 138

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2839 18/<strong>01</strong>/2<strong>01</strong>2 892.3/78/Bappeda dan PM Kepala Bappeda dan Penanaman Modal Kab. Bangli <strong>03</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627212840 18/<strong>01</strong>/2<strong>01</strong>2 <strong>01</strong>72/PL6/PH/2<strong>01</strong>2 Direktur Politeknik Negeri Sriwijaya <strong>03</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>245627202841 18/<strong>01</strong>/2<strong>01</strong>2 130/-084.21 Kepala Suku Dinas Kebersihan Jakarta Timur <strong>03</strong>/02/12 09‐2‐2<strong>01</strong>2 02<strong>01</strong>245626982842 18/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/127/Pegum2843 18/<strong>01</strong>/2<strong>01</strong>2 PL.02.06-BBPJN VI/XII/1829Sekretrais Dinas Pertanian Tanaman Pangan Pemprov.Jawa BaratKepala Balai Besar Pelaksanaan Jalan Nasional VI ,Makassar Ditjen Bina marga kementerian PekerjaanUmum<strong>03</strong>/02/12 07‐2‐2<strong>01</strong>2 02<strong>01</strong>24562717<strong>03</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>245627442844 18/<strong>01</strong>/2<strong>01</strong>2 S.76/IV-K.23/Peg/2<strong>01</strong>2 Kepala Balai Konservasi SDA Kalimantan Selatan <strong>03</strong>/02/12 06‐2‐2<strong>01</strong>2 02<strong>01</strong>245627412845 18/<strong>01</strong>/2<strong>01</strong>2 890/PU-UPTJKSDM/49 Sekretaris Dinas PU Pemprov. Riau 09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466332846 18/<strong>01</strong>/2<strong>01</strong>2 <strong>03</strong>37/B.04/<strong>01</strong>/2<strong>01</strong>2 Kabiro Perencanaan, Ortala Bappenas 05‐3‐ 2<strong>01</strong>2 02<strong>01</strong>28866270Tidak ada fotocopysertifikat2847 12/<strong>01</strong>/2<strong>01</strong>2 S-<strong>03</strong>/PJ.08/2<strong>01</strong>2Direktur Potensi, Kepatuhan dan Penerimaan DitjendPajak Kementerian Keuangan17‐2‐2<strong>01</strong>2 02<strong>01</strong>22946622Tidak ada SosialisasiPerpres 54, sudah dikirimpada tanggal 23 Februari2<strong>01</strong>22848 19/<strong>01</strong>/2<strong>01</strong>2 523.1/39/DKPP/I/2<strong>01</strong>2Kepala Dinas Kelautan, Perikanan Peternakan PemkabSumbawa Barat09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466222849 19/<strong>01</strong>/2<strong>01</strong>2 06/IAPI/SP/I/2<strong>01</strong>2 Wakil Sekretrais jenderal DPP IAPI 09/02/12 17‐2‐2<strong>01</strong>22850 19/<strong>01</strong>/2<strong>01</strong>2 TU.100/B1.18/2<strong>01</strong>2Plt. Kepala Dinas Kelautan dan Perikanan PemkabTimor Tengah Utara08‐3‐2<strong>01</strong>2 02<strong>01</strong>28866368Tidak ada sosialisasi perpres542851 19/<strong>01</strong>/2<strong>01</strong>2 S.218/BPDAS BB.02/2<strong>01</strong>1Kepala BPDAS Bone Bolango Ditjen Bina PengelolaanDAS dan Perhutanan Sosial Kemen Hut13/<strong>03</strong>/12 PD0208615 Sertifikat masih berlaku2852 19/<strong>01</strong>/2<strong>01</strong>2 S-42/PJ.<strong>03</strong>/2<strong>01</strong>22853 19/<strong>01</strong>/2<strong>01</strong>2 445/58/411.4<strong>01</strong>/2<strong>01</strong>22854 19/<strong>01</strong>/2<strong>01</strong>2 S-44/PJ.<strong>03</strong>/ 2<strong>01</strong>22855 19/<strong>01</strong>/2<strong>01</strong>2 Un.04/R/KS.<strong>01</strong>.7/0061/2<strong>01</strong>22856 19/<strong>01</strong>/2<strong>01</strong>2 16/SRT/K3/DJKA/I/12Direktur Direktorat Peraturan Perpajakan II DitjenPajak kementerian Keuangan RIDirektur Rumah Sakit Umum Daerah Nganjuk PemkabNganjukDirektur Peraturan Pajak II Ditjen Pajak KementerianKeuangan RIRektor Universitas Islam Negeri Sultan Syarif KasimRiauDirektur Prasarana Perkeretaapian DitjenPerkeretaapian Kementerian Perhubungan08‐3‐2<strong>01</strong>2 02<strong>01</strong>288662<strong>03</strong>09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294663109/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294663209/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>2294664009/02/12 20‐2‐2<strong>01</strong>2 02<strong>01</strong>22946747Tidak ada SosialisasiPerpres 54Hal 139

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2857 19/<strong>01</strong>/2<strong>01</strong>2 S-25/PJ.<strong>01</strong>3/2<strong>01</strong>22858 19/<strong>01</strong>/2<strong>01</strong>2 W3.PL.02.<strong>03</strong>-<strong>01</strong>2859 19/<strong>01</strong>/2<strong>01</strong>2 5<strong>03</strong>/009/KOPERINDAG-A/I/2<strong>01</strong>22860 19/<strong>01</strong>/2<strong>01</strong>2 800/1352861 19/<strong>01</strong>/2<strong>01</strong>2 893.3/<strong>03</strong>2862 19/<strong>01</strong>/2<strong>01</strong>2 524/<strong>01</strong>52863 19/<strong>01</strong>/2<strong>01</strong>2 0068/E3.5/I/2<strong>01</strong>2Sekretaris Direktorat Jenderal Ditjen PajakKementerian Keuangan RIKepala Kantor Wilayah Sumatera Barat KementerianHukum dan HAM RIKepala Dinas Koperasi, Perindustrian dan PerdaganganPemkab LandakBadan Lingkungan Hidup Daerah PemerintahKabupaten JayapuraKepala Dinas Pekerjaan Umum Dan PerumahanPemkab JayapuraKepala Dinas Peternakan Pemerintah KabupatenJayapuraDirektur Pembelajaran dan Kemahasiswaan DitjenPendidikan Tinggi Kemendiknas09/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>2294673609/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294672909/02/12 20‐2‐2<strong>01</strong>2 170931598000509/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>2294676209/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>2294676809/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294674113/<strong>03</strong>/12 PD0208610Sertifikat masih berlaku,Tidak ada SosialisasiPerpres 542864 19/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/042/Adm.Pemb Sekretaris Daerah Pemdakab Badung 10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467382865 19/<strong>01</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.02/Au/<strong>03</strong>2Kepala Balai Besar Wilayah Sungai PompenganJanaberang , Dijen SDA Kementerian PU05‐3‐2<strong>01</strong>2 02<strong>01</strong>28866350Tidak ada fotocopysertifikat2866 19/<strong>01</strong>/2<strong>01</strong>2 800/06/UPTD-ULP/I/2<strong>01</strong>2Kasubbag TU UPTD Layanan Pengadaan Barang/JasaPemerintah DPU Pemkot Banda Aceh10/02/12 20‐2‐2<strong>01</strong>2 02<strong>01</strong>229466392867 19/<strong>01</strong>/2<strong>01</strong>2 965/57/DISHUBKOMINFOKepala Dinas Perhubungan, Komunikasi danInformatika Pemprov Sulawesi Tengah27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946570Tidak ada SosialisasiPerpres 542868 20/<strong>01</strong>/2<strong>01</strong>2 020/130/I/2<strong>01</strong>2Kepala Dinas Kelautan dan Perikanan ProvinsiSumatera Utara08/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466202869 20/<strong>01</strong>/2<strong>01</strong>2 KS.<strong>01</strong>.<strong>01</strong>.2.1.1.637 Direktur RSUD Tarakan Pemprov Kalimantan Timur 08/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466672870 20/<strong>01</strong>/2<strong>01</strong>2 W.12.HI.05.07-20902871 20/<strong>01</strong>/2<strong>01</strong>2 PL.<strong>01</strong>.02/IV.H.1/0784/2<strong>01</strong>22872 20/<strong>01</strong>/2<strong>01</strong>2 S-06/WPJ.22/KP.02<strong>01</strong>/2<strong>01</strong>2Kepala Kanwil Kalimantan Selatan KementerianHukum dan HAM RIDirektur Utama RSUP Sanglah Denpasar Ditjen BinaUpaya Kesehatan kementerian Kesehatan RIKepala Kantor Pelayanan Pajak Pratama CikarangSelatan Kanwil DPJ Jawa Barat II Ditjen Pajak KemenKeu RI10/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>2294658109/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294673009/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467322873 20/<strong>01</strong>/2<strong>01</strong>2 Kd. 19.08/4/HM.00/144/2<strong>01</strong>2 Kepala Kantor Kota Bima Kementerian Agama 09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467262874 20/<strong>01</strong>/2<strong>01</strong>2 PL. <strong>01</strong>.<strong>01</strong>/I/<strong>01</strong>23/2<strong>01</strong>22875 20/<strong>01</strong>/2<strong>01</strong>2 B/213/I/2<strong>01</strong>2Direktur Politeknik Kesehatan Kupang KementerianKesehatan RISekretaris Badan Penelitian dan PengembanganKementerian Pertahanan RI10/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>2294658210/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>22946735Hal 140

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2876 20/<strong>01</strong>/2<strong>01</strong>2 275/-078.54A.n. Plt Kepala Badan Pengelola Lingkungan HidupDaerah Pemprov DKI Jakarta09/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467662877 20/<strong>01</strong>/2<strong>01</strong>2 226/-1.824Kepala Biro Perekonomian Sekretariat DaerahPemprov DKI Jakarta14/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>229465832878 20/<strong>01</strong>/2<strong>01</strong>2 -Institut Seni Indonesia Padang Panjang DepartemenPendidikan dan Kebudayaan14/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466642879 20/<strong>01</strong>/2<strong>01</strong>2 420/172/405.08/2<strong>01</strong>2 Kepala Dinas Pemerintah Kabupaten Ponorogo 09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467372880 20/<strong>01</strong>/2<strong>01</strong>2 024/UN7.ULP/KP/2<strong>01</strong>2 Ketua ULP Universitas Diponegoro 10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467442881 20/<strong>01</strong>/2<strong>01</strong>2 800/81Kepala Badan Perencanaan Pembangunan DaerahPemerintah Kota Medan12/<strong>03</strong>/12 14/<strong>03</strong>/12 PD0208759Sama dengan <strong>No</strong>. Surat800/812882 20/<strong>01</strong>/2<strong>01</strong>2 800/2268/PP -Tidak melampirkanfotocopy sertifikat yangtelah habis masa berlakunya2883 20/<strong>01</strong>/2<strong>01</strong>2 S-051/WBC.15/PSO/2<strong>01</strong>22884 20/<strong>01</strong>/2<strong>01</strong>2 800/32/SekrtKepala Pangkalan Sarana Operasi Tipe B PantoloanKanwil Sulawesi Ditjen Bea Cukai Kemen Keu RIKepala Dinas Pertanian Tanaman Pangan PemerintahKabupaten Sukabumi10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294664316/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229465962885 20/<strong>01</strong>/2<strong>01</strong>2 5456/PL1.R/LK/2<strong>01</strong>1 Direktur Politeknik Negeri Bandung 07/02/12 10‐2‐2<strong>01</strong>2 02<strong>01</strong>245626912886 24/<strong>01</strong>/2<strong>01</strong>2 S-<strong>01</strong>0/WPJ.22/KP.10<strong>01</strong>/2<strong>01</strong>2Kepala KPP Pratama Bogor, Kanwil DJP Jawa Barat IIDitjend Pajak Kem. Keuangan27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946671Tidak ada SosialisasiPerpres 542887 24/<strong>01</strong>/2<strong>01</strong>2 S-24/WPJ.<strong>01</strong>/BG.<strong>01</strong>04/2<strong>01</strong>2Kepala Kanwil Sumatera Utara Ditjend Pajak Kem.Keuangan09/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>245626942888 24/<strong>01</strong>/2<strong>01</strong>2 - Syaiful 14/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467452889 24/<strong>01</strong>/2<strong>01</strong>2 um.<strong>01</strong>.<strong>03</strong>-bc/17 Plt. Dir. Bina Teknik Ditjend Bina Marga Kem. PU 10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466442890 24/<strong>01</strong>/2<strong>01</strong>2 PD<strong>01</strong><strong>01</strong>CSI/30Kabag Kepegawaian dan Ortala Setjend Cipta KaryaKem. PU10/02/12 20‐2‐2<strong>01</strong>2 02<strong>01</strong>229466682891 24/<strong>01</strong>/2<strong>01</strong>2 10/DBM/I/2<strong>01</strong>2 Kepala Dinas Bina Marga Pemkab Bulukumba 10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467522892 24/<strong>01</strong>/2<strong>01</strong>2 W1.U/859/UM/I/2<strong>01</strong>2Panitera/Sekretaris Pengadilan Tinggi/Tipikor BandaAceh10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467462893 24/<strong>01</strong>/2<strong>01</strong>2 602.1/054/2<strong>01</strong>2 Kepala Badan Pengendalian Dampak Lingkungan Aceh 10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467312894 24/<strong>01</strong>/2<strong>01</strong>2 600/477/III.<strong>03</strong>/MSJ/I/2<strong>01</strong>2 Kepala Dinas PU Kab. Mesuji 10/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>22946624Hal 141

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2895 24/<strong>01</strong>/2<strong>01</strong>2 S.<strong>03</strong>/PSIK-PP/<strong>01</strong>.2<strong>01</strong>2 Pelaksana Program PSIK 10/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>229467392896 24/<strong>01</strong>/2<strong>01</strong>2 PD.02.<strong>01</strong>-Sr/51 Kepala Biro Perencanaan dan KLN, Setjend PU 08/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467312897 24/<strong>01</strong>/2<strong>01</strong>2 050/083/Set.I/Dinkes Plh. Kepala Dinas Kesehatan Kab. Paser 09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466262898 24/<strong>01</strong>/2<strong>01</strong>2 2852.24/29/04/2<strong>01</strong>2 Setda Pemkab Lampung Barat 07/<strong>01</strong>/12 18/<strong>01</strong>/12 02<strong>01</strong>24562927Sama dengan <strong>No</strong>. Surat600/321/04/2<strong>01</strong>12899 24/<strong>01</strong>/2<strong>01</strong>2 UM<strong>03</strong>02/Ab-I/20 Dir. Bina Penatagunaan SDAir Kem. PU2900 24/<strong>01</strong>/2<strong>01</strong>2 37/UM/PSP/I/2<strong>01</strong>229<strong>01</strong> 24/<strong>01</strong>/2<strong>01</strong>2 38/UM/PSP/I/2<strong>01</strong>2PPK Satker Pengembangan dan Peningkatan SaranaPerkeretaapian Ditjend Perkeretaapian Kem.PerhubunganPPK Satker Pengembangan dan Peningkatan SaranaPerkeretaapian Ditjend Perkeretaapian Kem.Perhubungan09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294662509/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>22946625Sama dengan <strong>No</strong>. Surat UM<strong>03</strong> 02/Ab-XII/3992902 24/<strong>01</strong>/2<strong>01</strong>2 045.2/215 Kepala Dinas Perhubungan Kab. Buton 15/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>2294655329<strong>03</strong> 24/<strong>01</strong>/2<strong>01</strong>2 B/133/I/2<strong>01</strong>2/Baharkam Dir. Pamobvit Badan Pemeliharaan Keamanan POLRI 08/<strong>03</strong>/12 02<strong>01</strong>28866369Tidak ada SosialisasiPerpres 542904 25/<strong>01</strong>/2<strong>01</strong>2 004/UN33.9/PM/2<strong>01</strong>2 Sekretaris LPKM Universitas Negeri Medan 13/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229465852905 25/<strong>01</strong>/2<strong>01</strong>2 TU.31/LLASDP/I/2<strong>01</strong>2Kasubag Tata Usaha Direktorat jenderal PerhubunganDarat Kementerian Perhubungan09/02/12 20‐2‐2<strong>01</strong>2 02<strong>01</strong>229466652906 25/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/1144/2<strong>01</strong>1Kepala Dinas Kehutanan dan Perkebunan PemerintahKabupaten Aceh Utara09/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>229465802907 25/<strong>01</strong>/2<strong>01</strong>2 41A/UM.0<strong>01</strong>/BPSNT/KPEK/I/2<strong>01</strong>2Kepala Balai Pelestarian Sejarah dan Nilai TradisionalYogyakarta Kementerian Kebudayaan dan Pariwisata09/02/12 16‐2‐2<strong>01</strong>2 02<strong>01</strong>229467432908 25/<strong>01</strong>/2<strong>01</strong>2 S.1<strong>01</strong>/Set-2/2<strong>01</strong>2Plt.Sekretaris Direktorat Jenderal Bina UsahaKehutanan kementerian Kehutanan08‐3‐2<strong>01</strong>2 02<strong>01</strong>28866204Tidak ada SosialisasiPerpres 542909 25/<strong>01</strong>/2<strong>01</strong>2 602/052/405.<strong>03</strong>.1/2<strong>01</strong>2 Plt. Sekretaris Daerah Pemkab Ponorogo 08‐3‐2<strong>01</strong>2 02<strong>01</strong>288663672910 25/<strong>01</strong>/2<strong>01</strong>2 890/020/DBP-set/I/2<strong>01</strong>22911 25/<strong>01</strong>/2<strong>01</strong>2 54/KPPI/I/2<strong>01</strong>2Kepala Dinas Bina Marga Dan Pengairan PemkabKubu RayaSekretaris Eksekutif Komite Pengamanan PerdaganganIndonesia08/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>2294663809/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>22946619Tidak ada SosialisasiPerpres 542912 25/<strong>01</strong>/2<strong>01</strong>2 Pemohon Moh. Yahya , ST , 13/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>28866362Hal 142

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2913 25/<strong>01</strong>/2<strong>01</strong>2 Pemohon Safrul A Tuwo 13/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663532914 25/<strong>01</strong>/2<strong>01</strong>2 933/A.Pemb.-NGK/12/<strong>01</strong>/2<strong>01</strong>2 Wakil Bupati Nagekeo 10/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229465862915 25/<strong>01</strong>/2<strong>01</strong>2 50/SES/DJSN/I/2<strong>01</strong>2 Sekretaris Dewan Jaminan Sosial Nasional RI 09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229467282916 25/<strong>01</strong>/2<strong>01</strong>2 600/07/SK/DPE-WK/2<strong>01</strong>2Kepala Dinas Pertambangan Dan Energi Pemkab Waykanan27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946677Tidak ada fotocopysertifikat2917 25/<strong>01</strong>/2<strong>01</strong>2 2852.24/30/04/2<strong>01</strong>2 Sekretaris Daerah Pemkab Lampung Barat 15/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>229467482918 25/<strong>01</strong>/2<strong>01</strong>2 PD.<strong>03</strong>.<strong>01</strong>/AT/25Kepala Balai Besar Wilayah Sungai CimanukCisanggarung Ditjen SDA Kementerian PU09/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467842919 25/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/024/BPBDKepala Badan Penenggulangan Bencana DaerahPemkab Bandung Barat08/<strong>03</strong>/12 02<strong>01</strong>28866373Tidak ada fotocopysertifikat, Tidak adaSosialisasi Perpres 542920 25/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/776Kepala Dinas Perhubungan Komunikasi danInformatika Pemerintah Provinsi Jawa Tengah08/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>245626932921 25/<strong>01</strong>/2<strong>01</strong>2 0238/T/IKIP PGRI/I/2<strong>01</strong>2 Rektor IKIP PGRI Madiun 09/02/12 17‐2‐2<strong>01</strong>2 02<strong>01</strong>229466452922 25/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/BPAD/025Sekretaris Badan Perpustakaan Arsip dan DokumentasiPemprov Riau27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946567Tidak ada SosialisasiPerpres 54, Sertifikat masihberlaku2923 25/<strong>01</strong>/2<strong>01</strong>2 PL.<strong>01</strong>.<strong>01</strong>/VIII.29/1254/2<strong>01</strong>1Kasubag TU Ditjen Pengendalian Penyakit DanPenyehatan Klingkungan Kemenkes RI09/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>229467492924 25/<strong>01</strong>/2<strong>01</strong>2 UM.05.02/BB/I/08 Kepala Balai Bendungan Ditjen SDA kementerian PU 15/02/12 21‐2‐2<strong>01</strong>2 02<strong>01</strong>229466662925 25/<strong>01</strong>/2<strong>01</strong>2 800/148/404.1<strong>03</strong>/2<strong>01</strong>22926 26/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/3/I/ULP2927 26/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/1007Kepala Dinas Sosial Tenaga Kerja dan TransmigrasiPemkab NgawiKepala Unit Layanan Pengadaan Sekretariat DaerahPemkab SubangKepala Balai Pengobatan Penyakit Paru-paru DinasKesehatan Pemprov DIY27‐2‐2<strong>01</strong>2 02<strong>01</strong>2294659217/02/12 24‐2‐2<strong>01</strong>2 24‐Feb‐2<strong>01</strong>224/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663072928 26/<strong>01</strong>/2<strong>01</strong>2 800/046/424.057/2<strong>01</strong>2 Kepala Dinas Bina Marga Pemkab Pasuruan 27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946669Tidak ada SosialisasiPerpres 54Tidak ada SosialisasiPerpres 542929 26/<strong>01</strong>/2<strong>01</strong>2 - Pemohon Mamak Abdul Malik, SE 16/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229465332930 26/<strong>01</strong>/2<strong>01</strong>2 713/UN25/TU.4/2<strong>01</strong>2 Pembantu Rektor II Universitas jember 17/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>22946571Hal 143

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2931 26/<strong>01</strong>/2<strong>01</strong>2 893/<strong>01</strong>42/BKD Kepala Badan Kepegawaian Daerah Pemkab Sleman 17/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229466092932 26/<strong>01</strong>/2<strong>01</strong>2 600/309/DSP/2<strong>01</strong>1 Kepala Dinas SDA dan Pemukiman Pemprov Banten 17/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>229466022933 26/<strong>01</strong>/2<strong>01</strong>2 29/-082.72934 26/<strong>01</strong>/2<strong>01</strong>2 443/DPT.0/PL 430 Sl/I/2<strong>01</strong>22935 26/<strong>01</strong>/2<strong>01</strong>2 SP-22/WPJ.06/KP.07/2<strong>01</strong>2Kepala Suku Dinas Pertamanan Kota Adm. JakartaSelatanSesditjen Perikanan Tangkap Kementerian Kelautandan PerikananKepala Kantor Pelayanan Pajak Pratama JakartaMenteng Satu Kanwil DJP Jakarta Barat Ditjen PajakKemenkeu RI17/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>2294653417/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>2294661317/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229465592936 26/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/47/426.112/2<strong>01</strong>2 Kepala Dinas Pertanian Pemkab Probolinggo 17/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>229466<strong>03</strong>2937 26/<strong>01</strong>/2<strong>01</strong>2 B/133/I/2<strong>01</strong>2/BaharkamDirektur Pamobvit Badan Pemeliharaan KeamananKepolisian Negara RI17/02/12 24‐2‐2<strong>01</strong>22938 26/<strong>01</strong>/2<strong>01</strong>2 B.35/SU-KU/I/2<strong>01</strong>2Kepala Biro Keuangan dan Umum Deputi Bidangpenempatan Badan Nasional Penempatan danPerlindungan TKI17/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229465322939 26/<strong>01</strong>/2<strong>01</strong>2 S-121/WBC.04/PSO/2<strong>01</strong>2Kepala Pangkalan Sarana Operasi Bea & CukaiTanjung balai Karimun Kanwil DJP Khusus KepulauanRiau Ditjen Bea & Cukai Kemen Keu RI27‐2‐2<strong>01</strong>2Sudah pernah dikonversi,Sertifikat masih berlaku2940 26/<strong>01</strong>/2<strong>01</strong>2 050/00872941 26/<strong>01</strong>/2<strong>01</strong>2 861/313/DKP/2<strong>01</strong>2Plt. Sekretariat Daerah Kepala Bappeda PemerintahKabupaten BatangKepala Dinas Kebersihan Dan Pertamanan PemkotTebing Tinggi20/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>2294657317/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229465992942 26/<strong>01</strong>/2<strong>01</strong>2 2500.005 Kepala Biro Umum Badan Pusat Statistik 08/<strong>03</strong>/12 2<strong>01</strong>288663392943 27/<strong>01</strong>/2<strong>01</strong>2 S-32/WPJ.22/KP.<strong>01</strong><strong>01</strong>/2<strong>01</strong>2Kepala KPP Pratama Bekasi Utara Kanwil DJP JawaBarat II Ditjend Pajak Kem. Keuangan27‐2=2<strong>01</strong>2 02<strong>01</strong>22946675Masih berlaku, Tidak adasosialisasiTidak ada fotocopysertifikat2944 27/<strong>01</strong>/2<strong>01</strong>2 - Amri 13/<strong>03</strong>/12 PD0208629 Sudah pernah dikonversi2945 27/<strong>01</strong>/2<strong>01</strong>2 IK<strong>01</strong>06-Ax.0902/107 Kepala Balai Besar Wilayah Sungai Citanduy 17/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663122946 27/<strong>01</strong>/2<strong>01</strong>2 470/19/Dukcapil/2<strong>01</strong>22947 27/<strong>01</strong>/2<strong>01</strong>2 183/079.1Kepala Dinas Kependudukan dan Catatan Sipil Kab.BangliKabiro Kepala Daerah dan Kerjasama Luar NegeriSetda Prov. DKI Jakarta17/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>2294654317/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>22946562Hal 144

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2948 27/<strong>01</strong>/2<strong>01</strong>2 004/MKT-LPKN/I/2<strong>01</strong>2 Deputi Bidang Pemasaran Kerjasama LPKN 17/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663222949 27/<strong>01</strong>/2<strong>01</strong>2 UM0<strong>01</strong>/4/24/Sekjen/KPEK/2<strong>01</strong>22950 27/<strong>01</strong>/2<strong>01</strong>2 020/J17.13.6/PPSH/2<strong>01</strong>22951 27/<strong>01</strong>/2<strong>01</strong>2 341/DJPB/PL.430.D5/1/2<strong>01</strong>2Sekretaris Jenderal Kementerian Pariwisata danEkonomi KreatifKepala Pusat Penelitian Sosial - Humaniora LemlitUniv. MulawarmanDirektur Usaha Budidaya Ditjend Perikanan BudidayaKementerian KP17/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>2294658917/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>2294655517/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229465932952 27/<strong>01</strong>/2<strong>01</strong>2 800/276/419.41/2<strong>01</strong>2 Kepala Dinas Kesehatan Kota Kediri 17/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229465632953 27/<strong>01</strong>/2<strong>01</strong>2 440/426/412.43/2<strong>01</strong>2 Kepala Dinas Kesehatan Kab. Bojonegoro 16/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229465602954 27/<strong>01</strong>/2<strong>01</strong>2 244/1.77/2<strong>01</strong>22955 27/<strong>01</strong>/2<strong>01</strong>2 800/<strong>03</strong>0/DISHUBKOMINFO/2<strong>01</strong>22956 27/<strong>01</strong>/2<strong>01</strong>2 SP-<strong>01</strong>4/WPJ.09/KP.10/2<strong>01</strong>2Kepala Puskesmas Kec. Kembangan Kota Adm.Jakarta BaratKepala Dinas Perhubungan, Kominfo Kab. BangkaSelatanKepala KPP Pratama Purwakarta, Kanwil Jawa Barat IDitjend Pajak Kem. Keuangan16/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>2294654917/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>229466182957 30/<strong>01</strong>/2<strong>01</strong>2 800/<strong>03</strong>7/404.3.14.1.006/2<strong>01</strong>2 Kepala SMKN 1 Sidoarjo 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229466742958 30/<strong>01</strong>/2<strong>01</strong>2 523.1/62/DKPP/I/2<strong>01</strong>2Kepala Dinas Kelautan, Perikanan Peternakan PemkabSumbawa BaratSama dengan <strong>No</strong>. Surat800/176/DISHUBKOMINFO/III/2<strong>01</strong>1Tidak ada sosialisasi, Masihberlaku27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946689 Sudah pernah dikonversi2959 30/<strong>01</strong>/2<strong>01</strong>2 Dinsos.460/09/NTT/I/2<strong>01</strong>2 Kepala Dinas Sosial Prov. NTT 20‐2‐2<strong>01</strong>2 02<strong>01</strong>22946680 Tidak ada sosialisasi2960 30/<strong>01</strong>/2<strong>01</strong>2 002.6-661 Sekretaris Daerah Kota Binjai 17/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465302961 30/<strong>01</strong>/2<strong>01</strong>2 - Kepala Dinas PU Kab. Bolaang Mongondow Utara 17/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>229466152962 30/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/0092/4<strong>01</strong>/2<strong>01</strong>2 Kepala SMKN 1 Boyolangu 17/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>229466172963 30/<strong>01</strong>/2<strong>01</strong>2 893.3/41/Bappeda Kepala Bappeda Kab. Klungkung 17/02/12 17/<strong>01</strong>/12 02<strong>01</strong>245629842964 30/<strong>01</strong>/2<strong>01</strong>2 704-1/UN10.16/PD/2<strong>01</strong>2 Rektor Univ. Brawijaya 17/02/12 20‐2‐2<strong>01</strong>2 02<strong>01</strong>22946678Tidak ada SosialisasiPerpres 54Tidak melampirkanfotocopy sertifikat2965 30/<strong>01</strong>/2<strong>01</strong>2 800/99/414.052/2<strong>01</strong>2 Kadinas PU Kab. Tuban 17/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>229465382966 30/<strong>01</strong>/2<strong>01</strong>2 S-219/WPJ.32/KP.07/2<strong>01</strong>2 Kepala KPP Pratama Karangnayar 24/02/12 02<strong>01</strong>22946612Tidak MelampirkanFotocopy SertifikatHal 145

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2967 30/<strong>01</strong>/2<strong>01</strong>2 -Aldias Sastra d/a Institut Seni IndonesiaPadangpanjang24‐2‐2<strong>01</strong>2 02<strong>01</strong>229466<strong>01</strong> Sertifikat Masih Berlaku2968 30/<strong>01</strong>/2<strong>01</strong>2 W13-A/227/KS.0<strong>01</strong>/I/2<strong>01</strong>2 Ketua Pengadilan Tinggi Agama Surabaya 17/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465452969 30/<strong>01</strong>/2<strong>01</strong>2 600/50/Adm.Pemb/2<strong>01</strong>2 Sekretaris Daerah Pemkab Tebo 17/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229465942970 30/<strong>01</strong>/2<strong>01</strong>2 510.2/22/KCS/I/2<strong>01</strong>2 Camat Sekongkang 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229465952971 30/<strong>01</strong>/2<strong>01</strong>2 060/09/Orpeg/I/2<strong>01</strong>22972 30/<strong>01</strong>/2<strong>01</strong>2 KP.405/1/2PKKPJT'122973 30/<strong>01</strong>/2<strong>01</strong>2 02/LPPN/I/2<strong>01</strong>22974 30/<strong>01</strong>/2<strong>01</strong>2 600/CT-PLLW/I/2<strong>01</strong>2/512975 30/<strong>01</strong>/2<strong>01</strong>2 00935/KP05<strong>01</strong>/I/2<strong>01</strong>2Kabiro Organisasi & Kepegawaian Setda Prov.Sulawesi BaratKapus Kajian Kemitraan dan Pelayanan JasaTransportasi Setjend Kem. PerhubunganDirektur Program Lembaga PengembanganPengetahuan Nusantara (LPPN)Kepala Dinas Cipta Karya dan Tata Ruang Kab.PelalawanKabiro Umum Badan Tenaga Nuklir Nasional(BAPETEN)17/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>2294654617/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>2294668717/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>2294659<strong>01</strong>7/02/12 23‐2‐2<strong>01</strong>2 02<strong>01</strong>2294657617/02/12 23‐2‐2<strong>01</strong>2 02<strong>01</strong>22946574Tidak MelampirkanKeterangan MengikutiSosialisasi Perpres no.54Tahun 2<strong>01</strong>02976 30/<strong>01</strong>/2<strong>01</strong>2 PL.04.<strong>01</strong>.3/087/2<strong>01</strong>2 Kabiro Keuangan dan BMN Setjend Kem. Kesehatan 17/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229465612977 30/<strong>01</strong>/2<strong>01</strong>2 045.2/69/2<strong>01</strong>2Kepala Dinas Kependudukan dan Pencatatan SipilPemkab Pekalongan17/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465502978 30/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/67/426.307/2<strong>01</strong>2Asisten Administrasi Sekretariat Daerah PemkabProbolinggo16/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229466072979 30/<strong>01</strong>/2<strong>01</strong>2 S-27/WPJ.20/KP.<strong>03</strong>/2<strong>01</strong>2Kepala KPP Pratama Pulogadung Kanwil DJP JakartaTimur Ditjen Pajak Kementerian Keuangan14/<strong>03</strong>/12 PD0208761Tidak melampirkanfotocopy sertifikat2980 30/<strong>01</strong>/2<strong>01</strong>2 S-53/BPP.05/2<strong>01</strong>1Kepala Balai Diklat Keuangan Yogyakarta BadiklatKeuangan Kementerian Keuangan16/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229466062981 30/<strong>01</strong>/2<strong>01</strong>2 523/I/UPT-SUPM/2<strong>01</strong>2/02aKepala UPT-SUPM Internasional Prov. Riau DinasPerikanan dan Kelautan Pemprov. Riau20‐2‐2<strong>01</strong>2 02<strong>01</strong>22946673Tidak ada sosialisasi perpres542982 30/<strong>01</strong>/2<strong>01</strong>2 B/144-09/20/08/DJKUATSekretaris Ditjend Kekuatan Pertahanan KementerianPertahanan RI16/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229466142983 30/<strong>01</strong>/2<strong>01</strong>2 UM.002/1/1/UPP.JLL-2<strong>01</strong>2Kepala Kantor Unit Penyelenggara Pelabuhan Kelas IIIJailolo16/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>229465722984 30/<strong>01</strong>/2<strong>01</strong>2 25/800/DPU/I/2<strong>01</strong>2 Dinas PU Pemkab Kutai Kartanegara 16/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>22946531Hal 146

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>2985 30/<strong>01</strong>/2<strong>01</strong>2 P.IV/Kp.02.3/25/2<strong>01</strong>2Kepala Pusdiklat Tenaga Administrasi Balitbang danDiklat Kementerian Agama16/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465562986 30/<strong>01</strong>/2<strong>01</strong>2 S.117/BTNK-1/2/2<strong>01</strong>2Kepala Balai Taman Nasional Kutai Ditjendperlindungan Hutan dan konservasi alam KementerianKehutanan20‐2‐2<strong>01</strong>2 02<strong>01</strong>22946684Tidak ada sosialisasi, Tidakmelampirkan fotocopysertifikat2987 30/<strong>01</strong>/2<strong>01</strong>2 TL.0<strong>01</strong>/12/1/Upp.Sly-2<strong>01</strong>2Kepala Kantor Unit Penyelenggara Pelabuhan Kelas IIISelayar16/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465292988 30/<strong>01</strong>/2<strong>01</strong>2 UM.0<strong>01</strong>/492/41/Upp.Bks-2<strong>01</strong>1Kepala Kantor Unit Penyelenggara PelabuhanBiringkassi16/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465542989 30/<strong>01</strong>/2<strong>01</strong>2 UK.120/51/11/Kupp.Sw-2<strong>01</strong>1 Kepala Kantor Unit Penyelenggara Pelabuhan Siwa 16/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>229466112990 30/<strong>01</strong>/2<strong>01</strong>2 11/2/KR.III/I/2<strong>01</strong>2 Kepala Bagian Umum Kantor Regional III BKN 20‐2‐2<strong>01</strong>2 02<strong>01</strong>229466922991 31/<strong>01</strong>/2<strong>01</strong>2 050/1/14/2<strong>01</strong>2 Kepala Dinas Perhubungan Peprov Maluku 27‐2‐2<strong>01</strong>2 02<strong>01</strong>22992 31/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/410/Perl/2<strong>01</strong>22993 31/<strong>01</strong>/2<strong>01</strong>2 S-1493/WPJ.11/KP.13.<strong>01</strong>/2<strong>01</strong>22994 31/<strong>01</strong>/2<strong>01</strong>2 0089/UN43/TU/2<strong>01</strong>22995 31/<strong>01</strong>/2<strong>01</strong>2 020.<strong>01</strong>/344.1/TU/XI/2<strong>01</strong>1Asisten Administrasi Umum Sekretariat DaerahPemkab BulelengKepala Kantor PPP Surabaya Karangpilang KanwilDJP Jatim I Ditjen Pajak Kemen Keu RIPembantu Rektor Bid. Adm. Umum Dan KeuanganUniversitas Sultan Ageng TirtayasaKepala Dinas Tenaga Kerja dan Transmigrasi PemkabKotawaringin Timur16/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>2294658728‐2‐2<strong>01</strong>2 02<strong>01</strong>2294666116/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>2294665228‐2‐2<strong>01</strong>2 02<strong>01</strong>22946654Tidak ada SosialisasiPerpres 54Sudah pernah dikonversi,Sertifikat Masih BerlakuSertifikat Masih Berlaku,Tidak MelampirkanKeterangan MengikutiSosialisasi Perpres no.54Tahun 2<strong>01</strong>0Tidak MelampirkanKeterangan MengikutiSosialisasi Perpres no.54Tahun 2<strong>01</strong>02996 31/<strong>01</strong>/2<strong>01</strong>2 UM.008/096/I/PL-12Kasubag TU Ditjen Perhubungan Udara Bandar UdaraFatmawati Soekarno Kementerian Perhubungan28‐2‐2<strong>01</strong>2 02<strong>01</strong>22946653Tidak MelampirkanFotocopy Sertifikat2997 31/<strong>01</strong>/2<strong>01</strong>2 732/H.22.13/LK/2<strong>01</strong>2 Kepala BAUK Universitas Tanjungpura 16/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663192998 31/<strong>01</strong>/2<strong>01</strong>2 12.a/DPPK/<strong>01</strong>.02.1/I/2<strong>01</strong>2Kepala Dinas Perumahan Pemukiman dan KebersihanPemkab Majene16/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>229465582999 31/<strong>01</strong>/2<strong>01</strong>2 800/18/DPU/I/2<strong>01</strong>2 Kepala DPU Pemkab Majene 16/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229466583000 31/<strong>01</strong>/2<strong>01</strong>2 <strong>027</strong>/32 Sekretaris Daerah Pemkab Pekalongan 16/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>2294655130<strong>01</strong> 31/<strong>01</strong>/2<strong>01</strong>2 050/104/404.212/2<strong>01</strong>2 Direktur RSUD Dr. Soeroto Pemkab Ngawi 08/<strong>03</strong>/12 PD.0208697Tidak ada SosialisasiPerpres 54Hal 147

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3002 31/<strong>01</strong>/2<strong>01</strong>2 824/25/417.110/2<strong>01</strong>2Asisten Pemerintahan, Perekonomian danPembangunan Sekretariat Daerah Pemkot Mojokerto16/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>2294655230<strong>03</strong> 31/<strong>01</strong>/2<strong>01</strong>2 028/060/Pemb Sekretaris Daerah Pemkab Paser 16/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229465413004 31/<strong>01</strong>/2<strong>01</strong>2 Pemb.500/22/53.17/I/2<strong>01</strong>2 Sekretaris Daerah Pemkab Sumba Tengah 16/02/12 22‐2‐2<strong>01</strong>2 TA3005 31/<strong>01</strong>/2<strong>01</strong>2 523/..../I/DKPP/2<strong>01</strong>2Kepala Dinas Kelautan Perikanan dan PeternakanPemkab Bengkulu Tengah17/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229466883006 <strong>01</strong>/02/2<strong>01</strong>2 64.a/K21/KU/2<strong>01</strong>2 Politeknik Negeri Kupang 17/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229466573007 <strong>01</strong>/02/2<strong>01</strong>2 S.411/IV-K.23/Peg/2<strong>01</strong>23008 <strong>01</strong>/02/2<strong>01</strong>2 <strong>027</strong>/429/Perl/2<strong>01</strong>23009 <strong>01</strong>/02/2<strong>01</strong>2 S-0047/WPJ.31/2<strong>01</strong>23<strong>01</strong>0 <strong>01</strong>/02/2<strong>01</strong>2 462/BPSDMKP.<strong>01</strong>/TU.210/I/2<strong>01</strong>23<strong>01</strong>1 <strong>01</strong>/02/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>01</strong>-Le/11Kepala Sub Bagian TU BKSDA Kalimantan SelatanDitjen Perlindungan Hutan Konservasi AlamKementerian KehutananAsisten Administrasi Umum Sekretariat DaerahPemkab BulelengKepala Kanwil DJP Nusa Tenggara Ditjen PajakKemenKeu RISekretaris Badan Pemngembangan SDM KelautanPerikanan Kementerian Perikanan KelautanKepala Puslitbang Sosekling Puslitbang SosialEkonomi dan Lingkungan Balitbang Kementerian PU08/<strong>03</strong>/12 02<strong>01</strong>2886634217/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>2294660408/<strong>03</strong>/12 02<strong>01</strong>2886633417/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>2294657808/<strong>03</strong>/11 02<strong>01</strong>288663333<strong>01</strong>2 <strong>01</strong>/02/2<strong>01</strong>2 800/068/Dikes/Set-C Kepala Dinas Kesehatan Pemkab Kapuas Hulu 17/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663163<strong>01</strong>3 <strong>01</strong>/02/2<strong>01</strong>2 522/83/2/20-LU/2<strong>01</strong>13<strong>01</strong>4 <strong>01</strong>/02/2<strong>01</strong>2 058/<strong>03</strong>5/DPE/2<strong>01</strong>23<strong>01</strong>5 <strong>01</strong>/02/2<strong>01</strong>2 W16/-A/204/KU.<strong>01</strong>/I/2<strong>01</strong>2Kepala Dinas Kehutanan dan Perkebunan PemerintahKabupaten Lampung UtaraKepala Dinas Pertambangan Dan Energi Pemkab MusiRawasPanitera/ Sekretaris Pengadilan Tinggi AgamaPalangkaraya17/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>2886632<strong>01</strong>7/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>2886631717/02/12 23‐2‐2<strong>01</strong>2 02<strong>01</strong>22946575<strong>03</strong><strong>01</strong>6 <strong>01</strong>/02/2<strong>01</strong>2 10/Ses.Kab-<strong>01</strong>1.329000/I/2<strong>01</strong>1 Sekretaris Komisi Pemilihan Umum Kab Bekasi 17/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229466933<strong>01</strong>7 <strong>01</strong>/02/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>03</strong>-SK/22Kepala Biro Keuangan Sekretariat jenderalKementerian Pekerjaan Umum17/02/12 23‐2‐2<strong>01</strong>2 02<strong>01</strong>229465793<strong>01</strong>8 <strong>01</strong>/02/2<strong>01</strong>2 524/DISNAK-UM/2<strong>01</strong>2/088 Kepala Dinas Peternakan Pemkab Pelalawan 17/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>22946536Hal 148

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3<strong>01</strong>9 <strong>01</strong>/02/2<strong>01</strong>2 524/DISNAK -UM/2<strong>01</strong>2/087 Kepala Dinas Peternakan Pemkab Pelalawan 16/02/12 24‐2‐2<strong>01</strong>2 02<strong>01</strong>2294661<strong>03</strong>020 <strong>01</strong>/02/2<strong>01</strong>2 445/176/RSUD/IX/2<strong>01</strong>1 Direktur RSUD Pemkab talaud 17/02/12 28‐2‐2<strong>01</strong>2 02<strong>01</strong>229466633021 <strong>01</strong>/02/2<strong>01</strong>2 594.4/22/Binpro Sekretrais Daerah Pemkab Tasikmalaya 16/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229465883022 <strong>01</strong>/02/2<strong>01</strong>2 523/153/2<strong>01</strong>23023 <strong>01</strong>/02/2<strong>01</strong>2 UM <strong>01</strong> 11-An/343024 <strong>01</strong>/02/2<strong>01</strong>2 600/042/DPU/I/2<strong>01</strong>2Sekretaris Dinas Kelautan dan Perikanan Pemkab AcehTamyangKabid Operasi dan Pemeliharaan Balai Besar WilayahSungai Bengawan Solo Ditjen SDA kementerian PUPlt. Kepala Dinas Pekerjaan Umum PemerintahKabupaten Sumbawa Barat17/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>2294660828‐2‐2<strong>01</strong>2 02<strong>01</strong>2294665917/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663563025 <strong>01</strong>/02/2<strong>01</strong>2 800/<strong>01</strong>81/05/2<strong>01</strong>2 Gubernur Lampung 16/02/12 22‐2‐2<strong>01</strong>2 02<strong>01</strong>229465473026 02/02/2<strong>01</strong>2 348/64/SBG/2<strong>01</strong>23<strong>027</strong> 02/02/2<strong>01</strong>2 523.000/78/DKP/2<strong>01</strong>23028 02/02/2<strong>01</strong>2 <strong>027</strong>/65/1.20.16/2<strong>01</strong>1Sekretaris Badan Gelogi Kementerian Energi danSumber Daya Mineral RIKepala Dinas Kelautan dan Perikanan PemerintahKabupaten MorotaiKepala Dinas Pendapatan, Pengelolaan Keuangan danAset Pemkab Bangka Barat22/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>2886636022/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>28866361<strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>2294654<strong>03</strong>029 02/02/2<strong>01</strong>2 <strong>027</strong>/09/406.096/2<strong>01</strong>2 Camat Tugu Pemkab Trenggalek 22/02/12 <strong>01</strong>‐3 ‐2<strong>01</strong>2 02<strong>01</strong>288663543<strong>03</strong>0 02/02/2<strong>01</strong>2 800/709/2<strong>01</strong>1 Sekretaris Dinas Bina Marga Pemkab Aceh Utara 09/<strong>03</strong>/12 PD02087153<strong>03</strong>1 02/02/2<strong>01</strong>2 59/PDN.1/SD/<strong>01</strong>/2<strong>01</strong>2 Sekretaris Ditjen Perdagangan Dalam Negeri 22/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663253<strong>03</strong>2 02/02/2<strong>01</strong>2 09<strong>03</strong>/J28/LL/2<strong>01</strong>2 Kepala LPMP Provinsi DKI Jakarta 22/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663323<strong>03</strong>3 02/02/2<strong>01</strong>2 B.212/SJ.4/PL.420/I/2<strong>01</strong>2Kepala Biro Hukum dan Organisasi SetjenKementerian Kelautan dan Perikanan17/02/12 17/02/123<strong>03</strong>4 02/02/2<strong>01</strong>2 106/TU.1<strong>01</strong>/B3/2<strong>01</strong>2 Sekretaris Utama BKKBN 24/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663263<strong>03</strong>5 02/02/2<strong>01</strong>2 523/<strong>03</strong>6./DKP/I/2<strong>01</strong>23<strong>03</strong>6 02/02/2<strong>01</strong>2 800/97/412.16/2<strong>01</strong>2Kepala Dinas Kelautan dan Perikanan Pemkab LuwuTimurKepala Bagian Administrasi Pembangunan SekretariatDaerah Pemkab Bojonegoro22/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>2886634624/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>28866345Hal 149

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3<strong>03</strong>7 02/02/2<strong>01</strong>2 600/214/BMP/2<strong>01</strong>2Kepala Dinas PU Bina Marga dan Pengairan PemkabMuara Enim08/<strong>03</strong>/12 PD0208693Tidak melampirkanfotocopy sertifikat3<strong>03</strong>8 02/02/2<strong>01</strong>2 050/056 Sekretaris DPRD Pemkab Batang 24/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663483<strong>03</strong>9 02/02/2<strong>01</strong>2 S/82/BP DAS CKY-1/2<strong>01</strong>2Kepala Balai Pelaksana Tugas Harian BalaiPengelolaan DAS Cimanuk-Citanduy Ditjen BinaPengelolaan DAS dan Perhutanan Sosial Kemenhut23/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663113040 02/02/2<strong>01</strong>2 028/ULP/2<strong>01</strong>2 Kepala ULP Barang/Jasa Pemkab Muara Enim 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02086453041 02/02/2<strong>01</strong>2 165/SJ.3/KOMINFO/<strong>01</strong>/2<strong>01</strong>2 Kepala Biro Keuangan Setjen Kominfo 24/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663143042 02/02/2<strong>01</strong>2 163/SJ.3/KOMINFO/<strong>01</strong>/2<strong>01</strong>2 Kepala Biro Keuangan Setjen Kominfo 24/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>28866385Tidak ada sosialisasiPerpres 543043 02/02/2<strong>01</strong>2 164/SJ.3/KOMNFO/2<strong>01</strong>2 Kepala Biro Keuangan Setjen Kominfo 24/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>2886631<strong>03</strong>044 02/02/2<strong>01</strong>2 Diskan.523/068.a/I/2<strong>01</strong>2 Kepala Dinas Kelautan dan Perikanan Pemkot Kupang 15/02/12 15‐2‐2<strong>01</strong>23045 <strong>03</strong>/02/2<strong>01</strong>2 600/121/Adm.Pemb Setd4ov. Nusa Tenggara Barat 24/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>288663493046 <strong>03</strong>/02/2<strong>01</strong>2 124/-076.38Kepala Sudin Perumahan dan Gedung Pemda JakartaUtara22/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663553047 06/02/2<strong>01</strong>2 523/<strong>01</strong>36/KP Hedher Yunus 13/02/12 14‐2‐2<strong>01</strong>2 02<strong>01</strong>229467593048 06/02/2<strong>01</strong>2 Sti.12/KP.<strong>01</strong>.1/85/2<strong>01</strong>2 Kepala STAIN Manado 22/02/12 08‐3‐2<strong>01</strong>2 PD02087273049 06/02/2<strong>01</strong>2 Kd.05.<strong>01</strong>/1/KP.<strong>01</strong>.2/204/2<strong>01</strong>2 Kepala Kantor Kementerian Agama Kab. Kerinci 22/02/12 07‐3‐2<strong>01</strong>2 PD02087283050 06/02/2<strong>01</strong>2 <strong>027</strong>/258/Penda/2<strong>01</strong>1 Kadinas Pendapatan Prov. Sumatera Utara 09/<strong>03</strong>/12 PD02087173051 06/02/2<strong>01</strong>2 050/095/431.211.3/2<strong>01</strong>2 Kadinas Kelautan dan Perikanan Kab. Situbondo 22/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>229465393052 06/02/2<strong>01</strong>2 B-190/N.1.2/Cu/<strong>01</strong>/2<strong>01</strong>2 Asisten Bidang Pembinaan Kejaksaan Tinggi Aceh <strong>03</strong>/04/12 02<strong>01</strong>28866335Tidak melampirkanfotocopy sertifikat yangtelah habis masa berlakunya3053 06/02/2<strong>01</strong>2 055/30.1/416-109/2<strong>01</strong>2Kepala Dinas PU Cipta Karya & Tata Ruang Kab.Mojokerto22/02/12 08‐3‐2<strong>01</strong>2 PD0208720Hal 150

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3054 06/02/2<strong>01</strong>2 B/1747/A4.3/2/2<strong>01</strong>2Kabiro Kepegawaian Badan Pengusahaan KawasanPerdagangan Bebas & Pelabuhan Bebas Batam22/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>288663473055 06/02/2<strong>01</strong>2 PD.<strong>01</strong>.07-Aq/80 Kepala BBWS Serayu Opak 24/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>288662813056 06/02/2<strong>01</strong>2 800/029/KPP-PP/II-2<strong>01</strong>2 Kakantor Pengelolaan Pasar Pemkot Padang Panjang 22/02/12 08‐3‐2<strong>01</strong>2 PD02087263057 06/02/2<strong>01</strong>2 PD.02.<strong>01</strong>-Sr/107a Kabiro Perencanaan dan KLN Setjend Kementerian PU 13/02/12 13‐2‐2<strong>01</strong>23058 06/02/2<strong>01</strong>2 553/UN4.2/UM.10/2<strong>01</strong>2 Rektor Univ. Hasanuddin 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>2886633<strong>03</strong>059 06/02/2<strong>01</strong>2 870/90/DPU-KB/I/2<strong>01</strong>2 Kadinas PU Kab. Kutai Barat 20/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663993060 06/02/2<strong>01</strong>2 080/121/Pemb Setdakot Parepare 24/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663133061 06/02/2<strong>01</strong>2 Dis.KP.523/SP.56/I/2<strong>01</strong>2 Kadinas KP Kab. Lembata 22/02/12 08‐3‐2<strong>01</strong>2 PD02087253062 06/02/2<strong>01</strong>2 91513.<strong>03</strong>4 Kepala BPS Prov. Papua Barat 12/<strong>03</strong>/12 PD0208673Tidak ada LampiranPendukung3063 06/02/2<strong>01</strong>2 DT.I.II/HM.<strong>01</strong>/1906/2<strong>01</strong>2 Dirjend Pendidikan Islam 20/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>2886640<strong>03</strong>064 06/02/2<strong>01</strong>2 S-171/WPJ.28/KP.07/2<strong>01</strong>2 Kepala KPP Pratama Kotabumi 09/<strong>03</strong>/12 PD02087183065 06/02/2<strong>01</strong>2 900/066/1.1-RSUD PROV/I/2<strong>01</strong>2 Wadir Umum & Keu RSUD Prov. Kepri 20/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465483066 06/02/2<strong>01</strong>2 In.10/B.II/HM.<strong>01</strong>/29/2<strong>01</strong>2 Rektor IAIN Sultan Maulana Hasanuddin - Banten 22/02/12 08‐3‐2<strong>01</strong>2 PD02087213067 06/02/2<strong>01</strong>2 523.1/52 Kadinas Kelautan Perikanan Kab. Kepulauan Aru 20/02/12 29‐2‐2<strong>01</strong>2 02<strong>01</strong>229465573068 06/02/2<strong>01</strong>2 125/DS/PRS/I/2<strong>01</strong>2 Kepala Dinas Sosial Prov. Kepulauan Riau 20/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229466913069 06/02/2<strong>01</strong>2 B-147/Setneg/PPKK/Dirut/02/2<strong>01</strong>2 Plt. Dirut Pusat Pengelolaan Komplek Kemayoran 20/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>2294669<strong>03</strong>070 06/02/2<strong>01</strong>2 050/00207 Setdakab Brebes 24/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>22946591Hal 151

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3071 06/02/2<strong>01</strong>2 523/<strong>03</strong>6/DKP/I/2<strong>01</strong>2 Kepala Dinas Kelautan Perikanan Kab. Luwu TimurSudah pernah dikonversi(kv. 421) & sertifikatdikirim oleh TIKI pada tgl.5 3 2<strong>01</strong>2 dgn <strong>No</strong>. Surat523/<strong>03</strong>6./DKP/I/2<strong>01</strong>23072 06/02/2<strong>01</strong>2 800/124/RSD/2<strong>01</strong>2 Direktur RSD Besemah 20/02/12 02‐3‐2<strong>01</strong>2 02<strong>01</strong>288663183073 06/02/2<strong>01</strong>2 441/UN35/KP/2<strong>01</strong>2 Rektor Univ. Negeri Padang 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663243074 06/02/2<strong>01</strong>2 S.36/RSUD/1.3.2/1.2<strong>01</strong>2 Direktur Utama RSUD Raden Mattaher Prov. Jambi 08/<strong>03</strong>/12 PD.02087083075 06/02/2<strong>01</strong>2 UM.<strong>01</strong>.11-Cl/61Direktur Pengembangan Penyehatan LingkunganPermukiman (PLP) Ditjend Cipta Karya Kem. PU24/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663093076 06/02/2<strong>01</strong>2 <strong>027</strong>/630/I/2<strong>01</strong>2 Setdakab Banyumas 24/02/12 27‐2‐2<strong>01</strong>2 02<strong>01</strong>229465983077 06/02/2<strong>01</strong>2 055/-072 Kepala Puskesmas Kecamatan Jagakarsa 24/02/12 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663963078 07/02/2<strong>01</strong>2 Dis.Pkl.523/SD3.02/I/12kKepala Dinas Kelautan dan Perikanan PemerintahProvinsi Nusa Tenggara Timur02/<strong>03</strong>/10 <strong>01</strong>‐3‐2<strong>01</strong>2 02<strong>01</strong>288663523079 07/02/2<strong>01</strong>2 600/18/DPU/I/2<strong>01</strong>2 Kepala Dinas Pekerjaan Umum Pemkot Subulussalam 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663063080 07/02/2<strong>01</strong>2 060/05/BPBD3081 07/02/2<strong>01</strong>2 46/DJU.1/PL08/I/2<strong>01</strong>23082 07/02/2<strong>01</strong>2 W9-Ff.DL.<strong>01</strong>.02-1583083 07/02/2<strong>01</strong>2 556/<strong>03</strong>3-a/Disbudpar-Set/2<strong>01</strong>2Sekretaris Badan Penanggulangan Bencana DaerahPemerintah Kabupaten Batang HariSekretaris Badan Peradilan Umum Mahkamah AgungRIKepala Kantor Imigrasi Pati Kanwil Jawa TengahKementerian Hukum dan HAM RIKepala Dinas Kebudayaan dan Pariwisata PemkotTanjungpinang24/02/12 05‐3‐2<strong>01</strong>2 PD020873609/<strong>03</strong>/12 PD0208712 Tidak ada sosialisasi09/<strong>03</strong>/12 PD020871324/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288662733084 07/02/2<strong>01</strong>2 800/27.A/413.023/2<strong>01</strong>2 Plt. Sekretaris Daerah Pemkab Lamongan 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288662973085 07/02/2<strong>01</strong>2 650/11/d.1/i/2<strong>01</strong>2 Kepala Dinas PU Pemkot Metro 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663083086 07/02/2<strong>01</strong>2 167/089.12Kepala Suku Dinas Perindustrian dan Energi KotaAdm. JakPus Pemprov DKI Jakarta24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663<strong>03</strong>3087 07/02/2<strong>01</strong>2 864/Dispora/104 Kepala Dinas Pemuda dan Olahraga Pemprov Riau 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>28866274Hal 152

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3088 07/02/2<strong>01</strong>2 <strong>027</strong>/0061/Diklat Kepala Badan Diklat Pemprov DIY 24/02/12 08‐3‐2<strong>01</strong>2 PD02086863089 07/02/2<strong>01</strong>2 <strong>027</strong>/<strong>01</strong>0Kepala Kantor Pengendalian Dampak LingkunganPemkab Gunung Kidul24/02/12 08‐3‐2<strong>01</strong>2 PD02087223090 07/02/2<strong>01</strong>2 AP.505/II/0<strong>01</strong>/2<strong>01</strong>2 Plh. Kabiro Adm Pemb. Setda Pemprov NTT 12/<strong>03</strong>/12 PD02086773091 07/02/2<strong>01</strong>2 <strong>027</strong>/184/437.33/2<strong>01</strong>2 Asisten Adm Umum Setda Pemkab Gresik 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288662983092 07/02/2<strong>01</strong>2 007/UCM/R/I/2<strong>01</strong>2 Purek I Universitas Cokroaminoto Makassar 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288662753093 07/02/2<strong>01</strong>2 21/SPK.5.12/02/2<strong>01</strong>2 Kepala Balai Standardisasi Metrologi Legal Regional II 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288663213094 07/02/2<strong>01</strong>2 260/SM.106/TMD/2<strong>01</strong>1 Kepala Bandar Udara Temindung Samarinda 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>288662993095 07/02/2<strong>01</strong>2 810/264/I/Dinkes Kepala Dinas Kesehatan Pemkab Bandung 24/02/12 08‐3‐2<strong>01</strong>2 PD02086843096 07/02/2<strong>01</strong>2 - - 23‐2‐2<strong>01</strong>2Sudah Lulus Pada bulan<strong>No</strong>vember 2<strong>01</strong>13097 07/02/2<strong>01</strong>2 Kementerian kesehatan 09/<strong>03</strong>/12 PD02086883098 08/02/2<strong>01</strong>2 25/PDN.4/SD/1/2<strong>01</strong>2Direktur Logistik & Sarana Distribusi DitjendPerdagangan Dalam Negeri24/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>288663573099 08/02/2<strong>01</strong>2 602/133-Pemb Setdakab Bogor 24/02/12 06‐3‐2<strong>01</strong>2 PD020874<strong>03</strong>100 08/02/2<strong>01</strong>2 25/I.9/TVRI/2<strong>01</strong>2 LPP TVRI 24/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>2886633131<strong>01</strong> 08/02/2<strong>01</strong>2 <strong>027</strong>/440/404.1.2.2/2<strong>01</strong>2 Setdakab Sidoarjo <strong>01</strong>/<strong>03</strong>/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>288662863102 08/02/2<strong>01</strong>2 800/128/PSDA-KB/2<strong>01</strong>2Kepala UPTPSDA Kualuh Barumun DinasPengelolaan SDA Prov. Sumatera Utara12/<strong>03</strong>/12 PD020867631<strong>03</strong> 08/02/2<strong>01</strong>2 893.3/377/436.7.6/2<strong>01</strong>2 Kepala Badan Kepegawaian & Diklat Kota Surabaya 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 02<strong>01</strong>288663933104 08/02/2<strong>01</strong>2 343/-077.72 Setd4ov. DKI Jakarta 12/<strong>03</strong>/12 02<strong>01</strong>28866372Tidak melampirkanfotocopy sertifikat3105 08/02/2<strong>01</strong>2 450/OPB/PL.430.D1/II/2<strong>01</strong>2 Dtjend Perikanan Budidaya Kementerian KP 24/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>288663583106 08/02/2<strong>01</strong>2 610/41/PSDA-PS/II/2<strong>01</strong>2 Kepala Dinas Pengelolaan SDA Kab. Pesisir Selatan 24/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>28866358Hal 153

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3107 08/02/2<strong>01</strong>2 S-134/KPU.02/BG.<strong>01</strong>/2<strong>01</strong>2 Kabag Umum KPP Bea & Cukai Tipe B - Batam 24/02/12 06‐3‐2<strong>01</strong>2 PD020873<strong>03</strong>108 08/02/2<strong>01</strong>2 <strong>027</strong>-52/BPP-LKT/2<strong>01</strong>2 Plt. Kepala Bappeda Kab. Langkat 24/02/12 07‐3‐2<strong>01</strong>2 PD02087323109 08/02/2<strong>01</strong>2 600/26/V/2<strong>01</strong>2 Setdakab Lahat 24/02/12 06‐3‐2<strong>01</strong>2 PD02087293110 08/02/2<strong>01</strong>2 552/DPB/PL.430.D1/II/2<strong>01</strong>2 Ditjend Perikanan Budidaya Kementerian KP 12/<strong>03</strong>/12 PD020867<strong>03</strong>111 08/02/2<strong>01</strong>2 UK59/I/BH-2<strong>01</strong>2Setditjend Perhubungan Laut KementerianPerhubungan12/<strong>03</strong>/12 PD0208671Tidak ada SosialisasiPerpres 54Tidak ada SosialisasiPerpres 543112 08/02/2<strong>01</strong>2 602/DBM-UM/412/2<strong>01</strong>2 Kadinas Bina Marga Prov. Sumatera Utara 24/02/12 06‐3‐2<strong>01</strong>2 02<strong>01</strong>288663593113 08/02/2<strong>01</strong>2 S.66/BDK-1.KAP/2<strong>01</strong>2 Kepala Balai Diklat Kehutanan - Bogor 12/<strong>03</strong>/12 PD02086723114 08/02/2<strong>01</strong>2 1863/70/SDM/2<strong>01</strong>2 Setditjend Migas Kementerian ESDM 12/<strong>03</strong>/12 2<strong>01</strong>28866390Tidak ada sosialisasiPerpres 54, Tidakmelampirkan fotocopysertifikatTidak melampirkanfotocopy sertifikat3115 08/02/2<strong>01</strong>2 UM.002/I/12/DJKA/2<strong>01</strong>2Kepala Kantor Administarstor Terminal Peti KemasGedebage - Bandung14/<strong>03</strong>/12 PD0208773 Seritifakt masih berlaku3116 08/02/2<strong>01</strong>2 06.02/BMSDA-KS/UM/II/2<strong>01</strong>2 Kadinas Bina Marga & SDA Kab. Kuantan Singingi 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD020865<strong>03</strong>117 08/02/2<strong>01</strong>2 46/BPPKP.1/SD/2/2<strong>01</strong>2Sekretaris Badan Pengkajian & PengembanganKebijakan Perdagangan06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 02<strong>01</strong>288662853118 08/02/2<strong>01</strong>2 - Kadinas Kebudayaan & Pariwisata Kab. Banggai 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02086433119 08/02/2<strong>01</strong>2 600/13/DPU-N/2<strong>01</strong>2 Kadinas PU Kab. Melawi 13/<strong>03</strong>/12 PD0208755 Sertifikat masih berlaku3120 08/02/2<strong>01</strong>2 W10.U3/42/PL.<strong>01</strong>/I/2<strong>01</strong>2 Sekretaris Pengadilan Negeri Jakarta Selatan 12/<strong>03</strong>/12 PD02085943121 08/02/2<strong>01</strong>2 259/UN48.5.2/TU/2<strong>01</strong>2 Rektor Univ. Pendidikan Ganesha 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02086443122 08/02/2<strong>01</strong>2 600/30/Adm.Pemb/II/2<strong>01</strong>2 Setdakot Lubuk Linggau 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02086423123 08/02/2<strong>01</strong>2 29/LPP-RRI/PLK/SEK/2<strong>01</strong>2 Kepala LPP TVRI 12/<strong>03</strong>/12 PD02086743124 08/02/2<strong>01</strong>2 893/154/BKD.Diklat Setdakab Badung 28/02/12 05‐3‐2<strong>01</strong>2 02<strong>01</strong>28866280Hal 154

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3125 08/02/2<strong>01</strong>2 28/PEMB-SDA/II/2<strong>01</strong>2 Setdakab Karimun 06/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD02086313126 08/02/2<strong>01</strong>2 420/2174/022/2<strong>01</strong>2 Setd4ov. Jawa Timur 07/<strong>03</strong>/12 15‐3‐2<strong>01</strong>2 02<strong>01</strong>290047753127 08/02/2<strong>01</strong>2 <strong>027</strong>/2/2<strong>01</strong>2 Wakil Bupati Majene 22/02/12 09‐3‐2<strong>01</strong>2 PD02086473128 08/02/2<strong>01</strong>2 893.3/1<strong>03</strong>/II/2<strong>01</strong>2 Kadinas PU Prov. Kalimantan Timur 07/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288663953129 09/02/2<strong>01</strong>2 S-358/PJ.<strong>01</strong>/UP.51/2<strong>01</strong>2Sekretariat Direktorat jenderal Kementerian KeuanganRI22/02/12 23‐2‐2<strong>01</strong>2 02<strong>01</strong>22946577Sama dengan <strong>No</strong>. Surat S-<strong>03</strong>/PJ.08/2<strong>01</strong>23130 09/02/2<strong>01</strong>2 058/53/BAPPEDABadan Perencanaan Pembangunan Daerah Pemkab.Banggai07/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD02086583131 09/02/2<strong>01</strong>2 Ku.102/Klm-Smg/12/Pk-12 Stasiun Klimatologi Semarang BMKG 08/<strong>03</strong>/12 02<strong>01</strong>2886634<strong>03</strong>132 09/02/2<strong>01</strong>2 AP.600/14/II/2<strong>01</strong>2 Setda Pemkab. Ende 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02086463133 09/02/2<strong>01</strong>2 HAM1-pl.02.<strong>03</strong>-253A Dirjend HAM Kementerian Hukum dan Ham RI 07/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288663943134 09/02/2<strong>01</strong>2 <strong>027</strong>/69/Sel BAPAPSI Pemkab Bandung 07/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 PD02086213135 09/02/2<strong>01</strong>2 050/Adm-Pemb/2<strong>01</strong>2/108 Setda Pemkab. Siak 07/<strong>03</strong>/12 15‐3‐2<strong>01</strong>2 PD02128673136 09/02/2<strong>01</strong>2 310622/J19/LL/2<strong>01</strong>2Lembaga Penjaminan Mutu Pendidikan KementerianPendidikan dan Kebudayaan Nasional Prov. SumateraUtara02/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 PD02086873137 10/02/2<strong>01</strong>2 S-239/WKN.15/NL.05/2<strong>01</strong>2Kantor Pelayanan Kekayaan Negara dan LelangKendari Departemen Keuangan RI06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02086493138 10/02/2<strong>01</strong>2 W7.Ea.PL.02.<strong>03</strong>-<strong>01</strong>08Lembaga Pemasyarakatan Klas I CipinangKementerian Hukum dan HAM RI12/<strong>03</strong>/12 PD0208598Sudah pernah dikonversi,Sertifikat masih berlaku,Tidak ada sosialisasi3139 10/02/2<strong>01</strong>2 600/299/DBM Dinas Bina Marga Pemprov. Sulawesi Selatan 02/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 02<strong>01</strong>288663983140 10/02/2<strong>01</strong>2 S.39/BPTH.Sum-1/2<strong>01</strong>2Balai Perbenihan Tanaman Hutan SumateraKementerian Kehutanan12/<strong>03</strong>/12 PD0208597 Tidak ada Sosialisasi3141 10/02/2<strong>01</strong>2 52/SJ-DAG.1-<strong>01</strong>/SD/2/2<strong>01</strong>2 Kementerian Perdagangan RI 02/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288662123142 10/02/2<strong>01</strong>2 800/269/Dalprog/12 Setda Pemkab. Sukabumi 02/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 PD0208685Hal 155

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3143 10/02/2<strong>01</strong>2 153/083.52Pusat Pelatihan Kerja Daerah Jakarta Barat Pemprov.DKI Jakarta<strong>01</strong>/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 02<strong>01</strong>2886626<strong>03</strong>144 10/02/2<strong>01</strong>2 B/75/II/2<strong>01</strong>2/Div TI Markas Besar Kepolisian Negara RI Divisi TI <strong>01</strong>/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 02<strong>01</strong>288662023145 10/02/2<strong>01</strong>2 002.6/109/APP/2<strong>01</strong>2 Setda Pemkab. Sumbawa <strong>01</strong>/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 PD02087233146 10/02/2<strong>01</strong>2 411.1/<strong>01</strong>31/II/BPMDes/2<strong>01</strong>23147 10/02/2<strong>01</strong>2 UM.<strong>01</strong>.06/PKPAM-JB/093148 10/02/2<strong>01</strong>2 81/SP/PKP-BB/II/2<strong>01</strong>2Badan Pemberdayaan Masyarakat dan Desa Pemprov.Kalimantan TengahSatuan kerja Pengembangan Kinerja PAM Jawa BaratKementerian PUSNVT Pengembangan Kawasan Permukiman BangkaBelitung Kementerian PU15/<strong>03</strong>/12 02<strong>01</strong>28866327 Tidak ada sosialisasi06/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>2886620606/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288662273149 10/02/2<strong>01</strong>2 131/OT.160/D.1.4/02/2<strong>01</strong>2 Sekretariat Direktorat Jenderal Kementerian Pertanian 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 02<strong>01</strong>288663843150 10/02/2<strong>01</strong>2 S-5<strong>03</strong>/WPJ.09/KP.08/2<strong>01</strong>23151 10/02/2<strong>01</strong>2 523/II/2<strong>01</strong>2/DISKAPERKantor Pelayanan Pajak Pratama Cimahi KementerianKeuangan RIDinas Kelautan dan Perikanan Pemkab. KepulauanSelayar06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD020865206/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD020866<strong>03</strong>152 10/02/2<strong>01</strong>2 B-1452/N.2.24/Cu.3/07/2<strong>01</strong>1 Kejaksaan Negeri Siantar 08/<strong>03</strong>/12 02<strong>01</strong>28866328 Sudah pernah dikonversi3153 10/02/2<strong>01</strong>2 900/211/Sekrt.1/2<strong>01</strong>2 Dinas Pendidikan Pemprov. Sumatera Selatan 13/<strong>03</strong>/12 PD0208754Tidak ada sosialisasiPerpres 543154 10/02/2<strong>01</strong>2 600/46/Bang-I/2/2<strong>01</strong>1 Setda Pemkab. Berau 07/<strong>03</strong>/12 15‐3‐2<strong>01</strong>2 PD02128713155 10/02/2<strong>01</strong>2 021/PK.1/DIN/BAUK-TU/02.2<strong>01</strong>2 Politeknik Kampar 07/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD02086623156 10/02/2<strong>01</strong>2 600/BMP-SET/164 Dinas Bina Marga dan Pengairan Pemkab. Kampar 08/<strong>03</strong>/12 02<strong>01</strong>288663293157 10/02/2<strong>01</strong>2 <strong>01</strong>4/Ro.4/TU/KPEK/II/2<strong>01</strong>2 Kementerian Pariwisata dan Ekonomi Kreatif 02/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 02<strong>01</strong>288663713158 10/02/2<strong>01</strong>2 <strong>027</strong>/029Kantor Perpustakaan dan Arsip Daerah Pemkab.Gunungkidul02/<strong>03</strong>/12 07‐3‐2<strong>01</strong>2 PD02087343159 10/02/2<strong>01</strong>2 800/SET/128 Dinas Kelautan Perikanan, Pertanian dan Kehutanan 08/<strong>03</strong>/12 02<strong>01</strong>288663363160 10/02/2<strong>01</strong>2 800/260-Tankim Provsu/2<strong>01</strong>2Dinas Penataan Ruang dan Permukiman Pemprov.Sumatera Utara06/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD0208632Sudah pernah dikonversiyang ke- 2Sama dengan <strong>No</strong>. Surat<strong>01</strong>1/Ro.4/M/KPBK/I/2<strong>01</strong>2Tidak ada surat permohonankonversiHal 156

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3161 10/02/2<strong>01</strong>2 PL.04.<strong>01</strong>.3/169/2<strong>01</strong>2 Sekretariat Jenderal Kementerian Kesehatan RI 02/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 02<strong>01</strong>288663743162 10/02/2<strong>01</strong>2 600/083Dinas PU, Pertambangan dan Perhubungan Pemkab.Supiori02/<strong>03</strong>/12 07‐3‐2<strong>01</strong>2 PD02087313163 10/02/2<strong>01</strong>2 <strong>027</strong>/250/DaiProgPemb Sekda Pemkab. Majalengka 02/<strong>03</strong>/12 07‐3‐2<strong>01</strong>2 PD02087413164 10/02/2<strong>01</strong>2 SDM.7.UM.<strong>01</strong>.<strong>01</strong>-053 Akademi Imigrasi Kementerian Hukum dan HAM RI 07/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288662073165 10/02/2<strong>01</strong>2 KP.<strong>01</strong>.02-BWS/MU/09 BWS Maluku Utara Kementerian PU 02/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD02086593166 10/02/2<strong>01</strong>2 <strong>027</strong>/304/AKP.Aset Setda Pemprov. Bali 02/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 02<strong>01</strong>288663923167 10/02/2<strong>01</strong>2 Kantor Otoritas Pelabuhan Belawa 02/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02087143168 13/02/2<strong>01</strong>2 - Anwar 13/<strong>03</strong>/12 PD02086<strong>01</strong>3169 13/02/2<strong>01</strong>2 B/75/II/2<strong>01</strong>2/Div.TI Kepala Divisi Teknologi Informasi POLRI 13/<strong>03</strong>/12 PD0208609Tidak Melampirkan SuratPermohonan KonversiSudah Pernah Konversi,Sertifikat Masih Berlaku,Tidak MelampirkanKeterangan MengikutiSosialisasi Perpres no.54Tahun 2<strong>01</strong><strong>03</strong>170 13/02/2<strong>01</strong>2 Ma.11.63/KS.00/060/2<strong>01</strong>2 Kepala Madrasah Aliyah Negeri Kementerian Agama 13/<strong>03</strong>/12 PD0208608 Sertifikat Masih Berlaku3171 13/02/2<strong>01</strong>2 <strong>027</strong>/58/437.12/2<strong>01</strong>2 Sekretaris Daerah Pemkab Gresik 13/<strong>03</strong>/12 PD02086073172 13/02/2<strong>01</strong>2 129/PPS.BTG/TU.210/II/2<strong>01</strong>23173 13/02/2<strong>01</strong>2 Sti.12/KP.<strong>01</strong>.1/85/2<strong>01</strong>2 Ketua STAIN ManadoKepala Pelabuhan Perikanan Samudera Bitung DitjenPerikanan Tangkap kementerian Kelautan danPerikanan06/<strong>03</strong>/12 08‐3‐2<strong>01</strong>2 PD0208724Tidak MelampirkanFotocopy SertifikatSudah pernah konversi samadengan surat <strong>No</strong>.Sti.12/KP.<strong>01</strong>.1/85/2<strong>01</strong>23174 13/02/2<strong>01</strong>2 AP.600/55/II/2<strong>01</strong>2 Sekretaris Daerah Pemkab Belu 06/<strong>03</strong>/12 09‐3‐2<strong>01</strong>2 PD02086483175 13/02/2<strong>01</strong>2 387a/UN29/LL/2<strong>01</strong>1 Rektor Universitas Haluoleo 12/<strong>03</strong>/12 PD0208595 Sertifikat masih berlaku3176 13/02/2<strong>01</strong>2 700/90/435.108/2<strong>01</strong>2 Kepala Dinas PU Bina Marga Pemkab Sumenep 09/<strong>03</strong>/12 PD0208711Tidak MelampirkanKeterangan MengikutiSosialisasi Perpres no.54Tahun 2<strong>01</strong>0Hal 157

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3177 13/02/2<strong>01</strong>2 S.98/BPKH IV-1/2<strong>01</strong>2Kepala Balai Pemantapan Kawasan Hutan Wilayah IVDitjen Planologi Kehutanan Kemenhut13/<strong>03</strong>/12 PD0208604Serifikat Masih Berlaku,Tidak MelampirkanFotocopy Sertifikat3178 13/02/2<strong>01</strong>2 045.2/120/Dalbang.2<strong>01</strong>2Kepala Bagian Pengendalian Pembangunan ULP SetdaPemkot Banjarmasin08/<strong>03</strong>/12 02<strong>01</strong>28866365Sertifikat masihberlaku/Tidak bisa konversi3179 13/02/2<strong>01</strong>2 -3180 13/02/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>03</strong>-BBPJN VI/II/216Kepala Dinas Pertanian Kehutanan dan KelautanPemkot PaluKepala Balai Besar Pelaksanaan Jalan Nasional VI ,Makassar Ditjen Bina Marga kementerian PekerjaanUmum13/<strong>03</strong>/12 PD02086<strong>03</strong> Sudah Pernah Konversi05/<strong>03</strong>/12 06/<strong>03</strong>/12 02<strong>01</strong>288662853181 13/02/2<strong>01</strong>2 - Riswan Efendi, SE 13/<strong>03</strong>/12 PD0208606Tidak Melampirkan SuratPermohonan Konversi3182 14/02/2<strong>01</strong>2 471/5.31-100/II/2<strong>01</strong>2 Sekretaris Utama Badan Pertanahan Nasional RI 08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 02<strong>01</strong>288662683183 14/02/2<strong>01</strong>2 59/Daglu.6.5/SD/02/2<strong>01</strong>2Direktur Pengamanan Perdagangan Ditjen PerdaganganLN08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 02<strong>01</strong>288662673184 14/02/2<strong>01</strong>2 800/53/DPU/2<strong>01</strong>2 Kepala DPU Pemkab Aceh Singkil 12/<strong>03</strong>/12 PD020860<strong>03</strong>185 14/02/2<strong>01</strong>2 055/429/416-021/2<strong>01</strong>2Kabiro Adm. Perekonomian Sekretaris Daerah PemkabMojokerto08/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD0208657Sudah pernah dikonversi,Sertifikat masih berlaku3186 14/02/2<strong>01</strong>2 600/152/SETDA/05/2<strong>01</strong>2 Sekretaris Daerah Pemkot Metro 08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 PD02086393187 14/02/2<strong>01</strong>2 020/5/Prog/I/2<strong>01</strong>0 Sekretaris Dinas Kesehatan Pemprov NTB 08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 PD02086053188 14/02/2<strong>01</strong>2 800/204/KepegKepala Dinas Tanaman Pangan dan HortikulturaPemkab Garut12/<strong>03</strong>/12 PD0208596Tidak melampirkanfotocopy sertifikat3189 15/02/2<strong>01</strong>2 446/0477/3.1/II/2<strong>01</strong>2Plt. Direktur RSUD Dr. H. Abdul Moeloek PemprovLampung08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 PD02086163190 15/02/2<strong>01</strong>2 W6.IMI.b-PR.<strong>01</strong>.04-307Kepala Kantor Imigrasi Kelas I Bandar LmapungKanwil Lampung kementerian Hukum dan HAM RI08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 PD02086173191 15/02/2<strong>01</strong>2 UM.002/B.255/II/PIP.Smg-12 Direktur Politeknik Ilmu Pelayaran Semarang 08/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>2886621<strong>03</strong>192 15/02/2<strong>01</strong>2 899.5/089/Set.Diperta/HSU/2<strong>01</strong>2Kepala Dinas Pertanian Tanaman Pangan danHoltikultura Pem Kab HSU08/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 PD02086613193 15/02/2<strong>01</strong>2 Kp.02.02.862 Direktur Utama RSUD Persahabatan 08/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>28866205Hal 158

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3194 15/02/2<strong>01</strong>2 SM.3<strong>01</strong>/1/4/DJPD/2<strong>01</strong>23195 15/02/2<strong>01</strong>2 800/0294/SekrSekretaris Ditjen Perhubungan Darat KementerianPerhubunganKepala Dinas Perindustrian dan Perdagangan PemprovSumatera Utara08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 02<strong>01</strong>2886626508/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288662083196 15/02/2<strong>01</strong>2 080/144/Pemb Sekretaris Daerah Kota Parepare pemkot Parepare 08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 PD02087443197 15/02/2<strong>01</strong>2 MTs.23.<strong>01</strong>/PP.00.5/116/2<strong>01</strong>2Kepala Madrasah Tsanawiyah Negeri ManadoKementerian Agama08/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288663913198 15/02/2<strong>01</strong>2 173/SJ/II/2<strong>01</strong>2 Sekretaris Jenderal KPU 08/<strong>03</strong>/12 12‐3‐2<strong>01</strong>2 02<strong>01</strong>288662113199 15/02/2<strong>01</strong>2 B/143-09/32/<strong>01</strong>/Korpaskhas Wakil Komandan Korps Pasuikan Khas TNI AU 08/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087483200 15/02/2<strong>01</strong>2 B.512/P2HP.0/KP.120/II/2<strong>01</strong>232<strong>01</strong> 15/02/2<strong>01</strong>2 30/1.7553202 15/02/2<strong>01</strong>2 081/Satker Buda/X/2<strong>01</strong>1Sekretaris Ditjen Pengolahan Dan Pemasaran HasilPerikanan Kementerian Kelautan dan PerikananLurah Tebet Timur Kota Adm. Jakarta SelatanPemerintah DKI JakartaSatker Bandara Depati Amir Pangkalpinang DitjenPerhubungan Udara Kementerian Perhubungan08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 02<strong>01</strong>2886626609/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 02<strong>01</strong>2886626312/<strong>03</strong>/12 14/<strong>03</strong>/12 2<strong>01</strong>28866217 Sudah pernah dikonversi32<strong>03</strong> 15/02/2<strong>01</strong>2 550/1.712.343204 15/02/2<strong>01</strong>2 <strong>027</strong>/1075/BPP/I/2<strong>01</strong>23205 15/02/2<strong>01</strong>2 800/0640/7.1/II/2<strong>01</strong>23206 16/02/2<strong>01</strong>2 S.167/SMK Kehut-1/2<strong>01</strong>2Kepala BLK Khusus Pengembangan LAS DinasTenaga Kerja dan Transmigrasi Pemprov DKI JakartaKepala Badan Penelitian dan Pengembangan PemprovSumatera UtaraDirektur Umum dan Keuangan RSUD Dr. H. AbdulMoeloek Pempropv LampungKepala Sekolah Menengah Kejuruan KehutananBPPSDM Kehutanan kemenHut09/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 02<strong>01</strong>2886626414/<strong>03</strong>/12 PD0208769 Sertifikat masih berlaku09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD020874609/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128733207 16/02/2<strong>01</strong>2 893.3/122.29/II/2<strong>01</strong>2 Kepala BKD Pemkab Karanganyar 14/<strong>03</strong>/12 PD0208770 Sertifikat masih berlaku3208 16/02/2<strong>01</strong>2 800/092/415.32/2<strong>01</strong>2Kepala Dinas Kehutanan dan Perkebunan PemkabJombang09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128723209 16/02/2<strong>01</strong>2 600/0089/PUK-II/2<strong>01</strong>2 Kepala Dinas PU Kabupaten Pemkab Tapanuli Utara 09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD0212875Hal 159

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3210 16/02/2<strong>01</strong>2 800/<strong>03</strong>95/I.1 Kepala Dinas Sosial Pemprov DIY 09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 02<strong>01</strong>290047753211 16/02/2<strong>01</strong>2 050/07/Pemb-II/II/2<strong>01</strong>2 Sekretaris Daerah Pemkab Nunukan 14/<strong>03</strong>/12 PD0208768 Sertifikat masih berlaku3212 16/02/2<strong>01</strong>2 S-158/WBC.14/KPP.MP/2<strong>01</strong>2Plh. Kepala Kanwil Kalimantan Bagian Timur DitjenBea dan Cukai kemenkeu RI14/<strong>03</strong>/12 PD0208771 Tidak ada sosialisasi3213 16/02/2<strong>01</strong>2 800/260-TARUKIM.PROVSU/2<strong>01</strong>2Kepala Dinas Penataan Ruang dan PermukimanPemprov SUMUT16/<strong>03</strong>/12 02<strong>01</strong>29004800Masih berlaku, <strong>No</strong>nsosialisasi, sudah pernahkonversi3214 16/02/2<strong>01</strong>2 Kd.<strong>01</strong>.07/KS.<strong>01</strong>.5/104/2<strong>01</strong>2Kepala Kantor Kementerian Agama Kabupaten AcehBesar kementerian Agama09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128743215 16/02/2<strong>01</strong>2 800/054/Nakkan/2<strong>01</strong>23216 16/02/2<strong>01</strong>2 2<strong>03</strong>/BPKIMI/BRSSd.1/II/2<strong>01</strong>2Plt. Kepala Dinas Peternakan dan Perikanan PemkabMusi RawasPlh Kepala Balai Riset dan Stadardisasi IndustriSamarinda Badan Pengkajian Kebijakan Iklim danMutu Industri14/<strong>03</strong>/12 2<strong>01</strong>28866214 Tidak ada sosialisasi09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087643217 16/02/2<strong>01</strong>2 381/-084.2Kepala Sudin Pemakaman Pemerintah KotaAdministrasi Jakarta Timur14/<strong>03</strong>/12 PD0208641Tidak ada sosialisasi, Masihberlaku3218 17/02/2<strong>01</strong>2 600/31.C/DPU/II/2<strong>01</strong>2 Dinas PU Pemprov. Sulawesi Barat 09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128783219 17/02/2<strong>01</strong>2 893.3/<strong>03</strong>/2<strong>01</strong>2 Dinas PU Pemkab. Pekalongan 09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087633220 17/02/2<strong>01</strong>2 41/800/DPU/I/2<strong>01</strong>2 Dinas PU Pemkab. Kutai Kartanegara 09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02086383221 20/02/2<strong>01</strong>2 861/56-Bapp/2<strong>01</strong>2Badan Perencanaan Pembangunan Daerah PemkabLebak14/<strong>03</strong>/12 2<strong>01</strong>28866216 Tidak ada sosialisasi3222 20/02/2<strong>01</strong>2 893.3/0478/26/2<strong>01</strong>2 Badan Kepegawaian Daerah Kab Boyolali 09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087473223 20/02/2<strong>01</strong>2 050/40/441.122/2<strong>01</strong>2 Setda Kab. Pamekasan 09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087523224 20/02/2<strong>01</strong>2 B/250/63/02/2<strong>01</strong>2Kabiro Umum Lembaga Penerbangan dan AntariksaNasional (LAPAN)09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087453225 20/02/2<strong>01</strong>2 800/242/414.1<strong>03</strong>/2<strong>01</strong>2 Sekretaris Daerah Pemkab Tuban 09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD0208766Hal 160

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3226 20/02/2<strong>01</strong>2 002/0559 Sekretaris Daerah Pemkot Sabang 09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087493227 20/02/2<strong>01</strong>2 <strong>027</strong>/97/ADM PEMBANGUNAN Sekretaris Daerah Kab. Barru 09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087653228 20/02/2<strong>01</strong>2 050/128/Bang Sekretaris Daerah Kota Jambi 08/<strong>03</strong>/12 13‐3‐2<strong>01</strong>2 PD02086183229 20/02/2<strong>01</strong>2 Kw.14.1/KP.<strong>01</strong>.2/383/2<strong>01</strong>2Kepala Kementerian Agama Kanwil Prov. KalimantanBarat09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 02<strong>01</strong>290047743230 20/02/2<strong>01</strong>2 893.3/BKD-Diklat/II/056 Kepala Badan Kepegawaian Daerah Kab. Bintan 14/<strong>03</strong>/12 PD0208756 Tidak ada sosialisasi3231 21/02/2<strong>01</strong>2 890/854/2<strong>01</strong>2Direktur RSJD Dr. RM. Soedjarwadi Prov. JawaTengah13/<strong>03</strong>/12 PD0208626 Sudah pernah dikonversi3232 21/02/2<strong>01</strong>2 890/250/Diklat/2<strong>01</strong>1 Badan Kepegawaian Diklat Kab. Aceh Barat Daya 07‐3‐2<strong>01</strong>2 PD02087333233 21/02/2<strong>01</strong>2 523/058/DKP/II/2<strong>01</strong>2Kepala Dinas Kelautan dan Perikanan Pemkab LuwuTimurSudah dikonversi ; samadengan <strong>No</strong>. Surat523/<strong>03</strong>6./DKP/I/2<strong>01</strong>2 &sertifikat dikirim oleh TIKIpada tgl. 5 3 2<strong>01</strong>2 dgn no.AWB 02<strong>01</strong>288663463234 21/02/2<strong>01</strong>2 800/66/411/2<strong>01</strong>2Kepala Dinas Perindustrian, Perdagangan dan ESDM,Kab. Jember13/<strong>03</strong>/12 PD0208753Tidak ada Sosialisasi, Masihberlaku, Tidak melampirkanfotocopy sertifikat3235 21/02/2<strong>01</strong>2 594.3/119/1Kepala Dinas Pertanian Tanaman Pangan danHortikultura Pemkab Grobogan13/<strong>03</strong>/12 PD0208619Tidak melampirkanfotocopy sertifikat; Samadengan <strong>No</strong>. Surat594.3/119/I3236 21/02/2<strong>01</strong>2 B/1<strong>01</strong>/II/2<strong>01</strong>2 Kepala Pusat Kesehatan Mabes TNISosialisasi Perpres 54,Sertifikat masih berlaku3237 21/02/2<strong>01</strong>2 Kw.06.1/5/HM.<strong>01</strong>/131/2<strong>01</strong>23238 21/02/2<strong>01</strong>2 W10.PAS.17-PL.02.<strong>03</strong>-1873239 21/02/2<strong>01</strong>2 524/190/419/2<strong>01</strong>23240 21/02/2<strong>01</strong>2 PD <strong>03</strong>02-Aq/175.2Kepala Kementerian Agma Kanwil Prov. SumateraSelatanPlt. Kepala Lembaga Pemasyarakatan Klas II BNGAwi KEmhukHAM Kanwil Jawa TimurKepala Dinas Peternakan Perikanan dan Kelautan Kab.JemberKepala BBWS Serayu Opak, Ditjend SDA,Kementerian PU09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD020875<strong>01</strong>3/<strong>03</strong>/12 PD0208627 Sertifikat masih berlaku13/<strong>03</strong>/12 PD0208625 Sertifikat masih berlaku13/<strong>03</strong>/12 PD0208622 Tidak ada SosialisasiHal 161

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3241 21/02/2<strong>01</strong>2 B.09/BPSPL.<strong>03</strong>/KP3K/I/2<strong>01</strong>2Kepala Balai Pengelolaan Sumberdaya Pesisir dan LautPontianak, Ditjend Kelautan Pesisir dan Pulau-pulauKecil, Kemnenterian Kelautan dan Perikanan13/<strong>03</strong>/12 PD0208624 Tidak ada Sosialisasi3242 21/02/2<strong>01</strong>2 523/DKP-Set/<strong>01</strong>9 Kadis Kelautan dan Perikanan Kab. Bintan 13/<strong>03</strong>/12 PD0208630 Sertifikat masih berlaku3243 21/02/2<strong>01</strong>2 UM.002/1/7/PPSDMA-2<strong>01</strong>2Kapus Pengembangan SDM Aparatur Perhubungan,Kem. Perhubungan09/<strong>03</strong>/12 14‐3‐2<strong>01</strong>2 PD02087723244 21/02/2<strong>01</strong>2 602/042/DBC/2<strong>01</strong>2 Kepala Dinas Bina Marga dan Cipta Karya Aceh 09/<strong>03</strong>/12 15‐3‐2<strong>01</strong>2 PD02128683245 21/02/2<strong>01</strong>2 152/SJ-DAG.ULP/SD/2/2<strong>01</strong>2 Kepala ULP Kementerian Perdagangan 13/<strong>03</strong>/12 PD0208623 Tidak ada sosialisasi3246 21/02/2<strong>01</strong>2 094/-077Kepala Panti Sosial Bina Laras Harapan Sentosa 1,Dinsos Prov DKI Jakarta13/<strong>03</strong>/12 PD0208628 Tidak ada sosialisasi3247 22/02/2<strong>01</strong>2 520/787-dpp/2<strong>01</strong>2Kepala Dinas Pertanian dan Peternakan Kab.Tangerang14/<strong>03</strong>/12 PD0208758Sudah pernah dikonversi;sama dengan <strong>No</strong>. Surat520/787-dpp/2<strong>01</strong>23248 22/02/2<strong>01</strong>2 B-364/0.2.32/Cp.1/02/2<strong>01</strong>2 Kepala Kejaksaan Negeri Cibadak Sertifikat masih berlaku3249 22/02/2<strong>01</strong>2 41/KR.X.K/II/2<strong>01</strong>2 Kuasa Pengguna Anggaran Kantor Regional X BKN 14/<strong>03</strong>/12 PD0208757 Sertifikat masih berlaku3250 22/02/2<strong>01</strong>2 S.175/SET-2/2<strong>01</strong>2 Sekretaris Direktorat Jendral 13/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 02<strong>01</strong>290047853251 22/02/2<strong>01</strong>2 KU-<strong>03</strong>.<strong>01</strong>-Rd/78 Direktur Pembinaan Penataan Ruang Daerah Wilayah I 13/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 02<strong>01</strong>290047773252 22/02/2<strong>01</strong>2 800/23/DESTARKIM/2<strong>01</strong>2Kepala Dinas Tata Ruang Dan Pemukiman KabupatenBekasi13/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128773253 23/02/2<strong>01</strong>2 810/1<strong>03</strong>4Kepala Badan Lingkungan Hidup Daerah IstimewaYogyakarta14/<strong>03</strong>/12 PD0208767Tidak melampirkanfotocopy sertifikat3254 23/02/2<strong>01</strong>2 <strong>027</strong>/149/Umum/2<strong>01</strong>1 Kepala Dinas Kesehatan Kab. Bangli 15/<strong>03</strong>/12 PD0212580<strong>No</strong>n sosialisasi, masihberlaku3255 23/02/2<strong>01</strong>2 045.2/104/pu.som/2<strong>01</strong>23256 23/02/2<strong>01</strong>2 DM.00.<strong>01</strong>.1.13/1497/2<strong>01</strong>2Kepala Dinas Pekerjaan Umum, Energi, dan SumberDaya Mineral Kabupaten PosoDirektur Rumah Sakit Kusta Dr. Rivai AbdullahPalembang13/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD021287615/<strong>03</strong>/12 02<strong>01</strong>28866224 Sertifikat masih berlakuHal 162

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3257 23/02/2<strong>01</strong>2 080/160/Pemb Sekretaris Daerah Kota Parepare pemkot Parepare 13/<strong>03</strong>/12 16‐3‐2<strong>01</strong>2 PD021286<strong>03</strong>258 23/02/2<strong>01</strong>2 S167/SMK Kehut-1/2<strong>01</strong>2Kepala Sekolah Menengah kejuruan KehutananBPPSDM Kehutanan kemenHut15/<strong>03</strong>/12 02<strong>01</strong>28866223Sudah pernah mengajukanlonversi sertifkat3259 24/02/2<strong>01</strong>2 SDM.7.UM.<strong>01</strong>.<strong>01</strong>-057 Direktur Akademi Imigrasi 15/<strong>03</strong>/12 02<strong>01</strong>28866222Tidak ada sosialisasiPerpres 543260 24/02/2<strong>01</strong>2 452/<strong>03</strong>.4/TU/2<strong>01</strong>2 Direktur Pembninaan SMK 15/<strong>03</strong>/12 02<strong>01</strong>288662213261 24/02/2<strong>01</strong>2 54/KPU-009-656820/II/2<strong>01</strong>2Plt Sekretaris Komisi Pemilihan Umum KabupatenBelitung TimurSertifikat masih berlaku,<strong>No</strong>n sosialisasi, Tidakmelampirkan suratpermohonan, Tidakmelampirkan fotocopysertifikat15/<strong>03</strong>/12 PD0212586 Sertifikat masih berlaku3262 24/02/2<strong>01</strong>2 690/049/PDAM/II/2<strong>01</strong>2 Direktur Utama PDAM Kab Wonosobo 15/<strong>03</strong>/12 02<strong>01</strong>28866220 Sertifikat masih berlaku3263 24/02/2<strong>01</strong>2 600/ /DPU/2<strong>01</strong>23264 24/02/2<strong>01</strong>2 893.3/123/II/Phb-2<strong>01</strong>2Kepala Dinas Pekerjaan Umum Kabupaten LombokTengahKepala Dinas Perhubungan Komunikasi danInformatika Provinsi Sulawesi tenggara15/<strong>03</strong>/12 PD0212581 Sertifikat masih berlaku15/<strong>03</strong>/12 02<strong>01</strong>28866219 Sertifikat masih berlaku3265 24/02/2<strong>01</strong>2 Kd.26.<strong>03</strong>/1/KS.00/154/2<strong>01</strong>2 Kepala Kantor Kabupaten Merauke 15/<strong>03</strong>/12 PD0212582 Sertifikat masih berlaku3266 24/02/2<strong>01</strong>2 MTs.23.12/06/PP.00/<strong>027</strong>/2<strong>01</strong>2Kepala Madrasah Tsanawiyah Negeri BolangitangTimur15/<strong>03</strong>/12 02<strong>01</strong>28866218 Sertifikat masih berlaku3267 27/02/2<strong>01</strong>2 P.IV/KP.023/76/2<strong>01</strong>2Kepala Pusdiklat Tenaga Administrasi Balitbang danDiklat Kementerian Agama15/<strong>03</strong>/12 PD0212583Tidak ada sosialisasiPerpres 543268 27/02/2<strong>01</strong>2 - Ir. Elprida Tampubolon 15/<strong>03</strong>/12 PD0212584 Sertifikat masih berlaku3269 28/02/2<strong>01</strong>2 Um.<strong>01</strong>.11-Rs/252 Sekretaris Direktorat Jendral Penataan Ruang 15/<strong>03</strong>/12 16-3-2<strong>01</strong>2 PD02128613270 28/02/2<strong>01</strong>2 MTs.23.12/06/PP.00/<strong>03</strong>3/2<strong>01</strong>2Kepala Madrasah Tsanawiyah Negeri BolangitangTimurSama dengan <strong>No</strong>. SuratMTs.23.12/06/PP.00/<strong>027</strong>/2<strong>01</strong>23271 28/02/2<strong>01</strong>2 Kw.12.1/1/OT.<strong>01</strong>.3/452/2<strong>01</strong>2Kepala Kementrian Agama Kanwil. Propinsi DaerahIstimewa Yogyakarta16/<strong>03</strong>/12 16‐3‐2<strong>01</strong>2 PD0212862Hal 163

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3272 09/02/2<strong>01</strong>2 W20.UM.<strong>01</strong>.<strong>01</strong>-449 Kementerian Hukum dan HAM RI kanwil Jambi 12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD021266<strong>03</strong>273 13/02/2<strong>01</strong>2 83/KP<strong>03</strong>08/BWSK.I/2<strong>01</strong>23274 13/02/2<strong>01</strong>2 S.629/IV-K.23/Peg/2<strong>01</strong>2Kepala Sub Bagian Tata Usaha BWS Kalimantan IDitjen SDA Kementerian PUKepala Balai Konservasi Sumber Daya AlamKalimantan Selatan Ditjen Perlindungan Hutan danKonservasi Alama Kementerian Kehutanan12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD021285112/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD02126613275 13/02/2<strong>01</strong>2 800/211/1.04/12 Kepala Bagian Adm. Pemb. Pemkot Bandar Lampung 12/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128553276 13/02/2<strong>01</strong>2 050/0486 Sekretaris Daerah Pemkot Pekalongan 12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD02128533277 13/02/2<strong>01</strong>2 B/059/II/2<strong>01</strong>2 Kepala Biro Hukum Setjen Kemhan 12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 02<strong>01</strong>288662093278 13/02/2<strong>01</strong>2 UM.0<strong>01</strong>/119/BPPP.MKS/KPEK/2<strong>01</strong>2Kepala Balai Pelestarian Peninggalan PurbakalaMakassar Kementerian Pariwisata dan Ekonomi Kreatif12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD02128523279 13/02/2<strong>01</strong>2 AP/600/65/II/2<strong>01</strong>2 Sekretaris Daerah Pemkab Belu 12/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128563280 13/02/2<strong>01</strong>2 <strong>027</strong>/136-DKPS/2<strong>01</strong>23281 13/02/2<strong>01</strong>2 833/35/404.312/2<strong>01</strong>2Kepala Dinas Kependudukan dan Pencatatan SipilPemkot TangerangKepala Pelaksana Badan Penanggulangan BencanaDaerah Pemkab Ngawi12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD021283312/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD02128693282 13/02/2<strong>01</strong>2 800/<strong>01</strong>99/404.6.6/2<strong>01</strong>2 Kepala Badan Pertahanan Pangan Pemkab Sidoarjo 12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 02<strong>01</strong>229465353283 13/02/2<strong>01</strong>2 Sti.17.2b/KP.07.1/176/2<strong>01</strong>2 Ketua STAIN Datokarama Palu 12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 02<strong>01</strong>229465373284 13/02/2<strong>01</strong>2 - Kepala Dinas PU Pemkab Muna 12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD02126573285 14/02/2<strong>01</strong>2 602/<strong>027</strong>/VI/SDA3286 15/02/2<strong>01</strong>2 S.204/Set-2/2<strong>01</strong>23287 15/02/2<strong>01</strong>2 594.3/119/I3288 15/02/2<strong>01</strong>2 KP.405/I/3/DJPU-2<strong>01</strong>2Kepala Dinas Pengelolaan SDA Pemprov SumateraUtaraSekretrais Direktorat Jenderal Bina Usaha Kehutanankementerian KehutananKepala Dinas Pertanian Tanaman Pangan danHoltikultura Pemkab GroboganSekretrais Direktorat jenderal Perhubungan UdaraKementerian Perhubungan13/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD021265609/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD021283509/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD021287<strong>01</strong>2/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 02<strong>01</strong>29004779Hal 164

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3289 15/02/2<strong>01</strong>2 10/9.2-100.9/II/2<strong>01</strong>2 Kepala Pusat Pendidikan dan Pelatihan BPN 09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128583290 16/02/2<strong>01</strong>2 S-177/WPJ.22/BG.<strong>01</strong>/2<strong>01</strong>2Kepala Kantor Wil DJP Jawa Barat II Ditjen PajakkemenKeu RI09/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD02126583291 16/02/2<strong>01</strong>2 524/326/409.115/2<strong>01</strong>2 Kepala Dinas Peternakan Pemkab Blitar 09/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 PD02126793292 20/02/2<strong>01</strong>2 441/143/Dikes/II/2<strong>01</strong>2 Kepala Dinas Kesehatan Kab. Sumbawa Barat 09/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD02128343293 17/02/2<strong>01</strong>2 050/09/APP/2<strong>01</strong>2 Setda Pemkab. Dompu 09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128543294 21/02/2<strong>01</strong>2 800/15/SDV/PA/2<strong>01</strong>2 Sekretaris Daerah Pemkot Pagar Alam 09/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD02128593295 23/02/2<strong>01</strong>2 028/1138/BPP/I/2<strong>01</strong>2Kepala Badan Penelitian Dan Pengembangan ProvinsiSumatera Utara13/<strong>03</strong>/12 21/<strong>03</strong>/12 02<strong>01</strong>290047733296 24/02/2<strong>01</strong>2 487/UN44/LL/2<strong>01</strong>2 Pembantu Rektor Bid. Akademik Unversitas Khairun 15/<strong>03</strong>/12 19-3-2<strong>01</strong>2 PD02125893297 24/02/2<strong>01</strong>2 800/I/202-Setwan Sekretaris DPRD Kota Bandung 13/<strong>03</strong>/12 20-3-2<strong>01</strong>2 02<strong>01</strong>290047843298 23/02/2<strong>01</strong>2 S-389/WPJ.09/2<strong>01</strong>23299 23/02/2<strong>01</strong>2 353/-078.4Kepala Kantor Wilayah Direktorat Jendral Pajak JawaBarat IKepala Suku Dinas Kebudayaan Kota AdministrasiJakarta Pusat13/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>2900477213/<strong>03</strong>/12 19‐3 2<strong>01</strong>2 PD02125883300 24/02/2<strong>01</strong>2 B/92/II/2<strong>01</strong>2 Kepala Bekangdam III/Siliwangi 16/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>2900476933<strong>01</strong> 17/02/2<strong>01</strong>2 523.21/31 Dinas Kelautan dan Perikanan Pemkab. Buton 19‐3‐2<strong>01</strong>2 PD02125873302 13/02/2<strong>01</strong>2 B-176/N.10.2/Cp.1/02/2<strong>01</strong>2Kepala Kejaksaan Tinggi Kepulauan Riau TanjungPinang12/<strong>03</strong>/12 20‐3‐2<strong>01</strong>2 PD021265933<strong>03</strong> 02/<strong>03</strong>/2<strong>01</strong>2 0<strong>01</strong>/LKI‐Konversi/II/2<strong>01</strong>2 Ketua Lembaga Kajian Indonesia 15/<strong>03</strong>/12 15‐3‐2<strong>01</strong>23304 06/<strong>03</strong>/2<strong>01</strong>2 UM<strong>01</strong><strong>03</strong>‐cl/PPLP‐SS/021/2<strong>01</strong>2 Kepala Satker Pengembangan PLP Sulel 15/<strong>03</strong>/12 15‐3‐2<strong>01</strong>23305 06/02/2<strong>01</strong>2 <strong>027</strong>/<strong>03</strong>0-PK/2<strong>01</strong>2 Setdakota Cirebon 12/<strong>03</strong>/12 19‐3‐2<strong>01</strong>2 PD0212857Hal 165

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3306 07/02/2<strong>01</strong>2 sp-27/wpj.12/kp.04<strong>01</strong>/2<strong>01</strong>2KPP Pratama Batu Kanwil Jawa Timur III DJP KemenKeu RI12/<strong>03</strong>/12 20/<strong>03</strong>/12 PD02086363307 13/02/2<strong>01</strong>2 SM.005/I/10/DNG.PLG-2<strong>01</strong>2 Kepala Distrik Navigasi Kelas I Palembang 12/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>290047663308 15/02/2<strong>01</strong>2 PEG.800/166/2<strong>01</strong>23309 16/02/2<strong>01</strong>2 61.000.<strong>01</strong>53310 16/02/2<strong>01</strong>2 30/SPK.5.10/SD/2/2<strong>01</strong>23311 17/02/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>03</strong>-Ku/543312 20/02/2<strong>01</strong>2 520/787-dpp/2<strong>01</strong>2Kepala Dinas Bina Marga dan Cipta Karya PemkabPidieKepala Badan Pusat Statistik Provinsi KalimantanBaratKepala Balai Standardisasi Metrologi Legal RegionalIVPusat Pembinaan Usaha dan Kelembagaan KementrianPUKepala Dinas Pertanian dan Peternakan Kab.Tanggerang15/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 PD021268509/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>2900476009/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 PD021284909/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>2900473409/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 PD02128393313 20/02/2<strong>01</strong>2 PL0704 Kapusdiklat Setjend Kementerian PU 09/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>290047613314 20/02/2<strong>01</strong>2 045.2/44/DBMP/SET-CSekretaris Dinas Bina mArga dan Pengairan PemkabKapuas Hulu09/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 PD02128483315 21/02/2<strong>01</strong>2 B/310/II/2<strong>01</strong>2 Sekretaris Ditjend Perencanaan Pertahanan Kemhan 09/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>290047353316 21/02/2<strong>01</strong>2 02180/J7/LL/2<strong>01</strong>23317 21/02/2<strong>01</strong>2 <strong>027</strong>/130/Sekrt3318 21/02/2<strong>01</strong>2 <strong>027</strong>/133/Sekrt3319 21/02/2<strong>01</strong>2 800/189/UMPEG3320 21/02/2<strong>01</strong>2 UM.0<strong>03</strong>/1/17/PLP.TPR-12Kepala Pusat Pengembangan dan PemberdayaanPendidik dan Tenaga Kependidikan Bisnis danPariwisata KemdikbudDinas Kependudukan dan Pencatatan Sipil PemkabBandungKepala Badan Perpustakaan Arsip dan PengembanganSistem Informasi Kab. Bandung (BAPAPSI)Kepala Dinas Pertanian Perkebunan dan KehutananPemkab BandungKepala Pangkalan PLP Tanjung Perak Surabaya,Ditjend Perhubungan Laut, Kementerian Perhubungan09/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>2900474109/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>2900473209/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>2900474413/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>2900473313/<strong>03</strong>/11 22‐3‐2<strong>01</strong>2 02<strong>01</strong>29004745Hal 166

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3321 21/02/2<strong>01</strong>2 800.08/210/BPSBTPH/02.123322 21/02/2<strong>01</strong>2 <strong>027</strong>/60/430.10.3/2<strong>01</strong>23323 21/02/2<strong>01</strong>2 <strong>027</strong>/649/Perl/2<strong>01</strong>23324 21/02/2<strong>01</strong>2 800/097/2<strong>01</strong>2Kepala Balai Pengawasan dan Sertifikasi BenihTanaman Pangan dan Hortikultura Prov. KalimantanSelatan, Dinas Pertanian Tanaman Pangan danHortikultura Prov. Kalimantan SelatanKepala Dinas Kependudukan dan Pencatatan Sipil Kab.BondowosoAsisten Administrasi Umum Sekretariat DaerahPemkab BulelengKepala Dinas Pertanian Tanaman Pangan PemerintahAceh09/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 PD021277309/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 PD021284709/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 PD021284609/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 PD02126773325 21/02/2<strong>01</strong>2 800/377/PP Sekretaris Daerah Kab. Karangasem 09/<strong>03</strong>/12 26‐3‐2<strong>01</strong>2 PD02126883326 21/02/2<strong>01</strong>2 1<strong>03</strong>7/DPT.0/TU210S1/II/2<strong>01</strong>2 Sekretaris Ditjend Perikanan Tangkap, Kem. KP 09/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>290047623327 21/02/2<strong>01</strong>2 PR.<strong>01</strong>.02.212.02.12.0684 Kepala Biro Perencanaan dan Keuangan Badan POM 09/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>290047513328 22/02/2<strong>01</strong>2 521/<strong>01</strong>8/BP4K/I/2<strong>01</strong>2Kepala Badan Pelaksana Penyuluhan PertanianPerikanan Kehutanan Kab Sumbawa Barat12/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 PD02128453329 22/02/2<strong>01</strong>2 800/372/2<strong>01</strong>2 Sekretariat Daerah Pemkab Purworejo 15/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>290047683330 22/02/2<strong>01</strong>2 522/123/KPPKEKepala Dinas Kelautan Perikanan Pertanian KehutananDan Energi Kota Tanjung Pinang12/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 PD02128443331 22/02/2<strong>01</strong>2 <strong>027</strong>/640/111.<strong>03</strong>/2<strong>01</strong>2 Kepala Dinas PU. Pengairan Provinsi Jawa Timur 15/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>290047593332 22/02/2<strong>01</strong>2 <strong>027</strong>/1137.1 Kepala Dinas Kelautan dan Perikanan 13/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>2900475<strong>03</strong>333 22/02/2<strong>01</strong>2 20.3/17.0/TU.230/II/2<strong>01</strong>2Balai Karantina Ikan, Pengendalian Mutu danKeamanan Hasil Perikanan Kelas II Semarang13/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 02<strong>01</strong>290047523334 23/02/2<strong>01</strong>2 002\0575\I Kepala Badan Ketahanan Pangan Dan Penyuluhan 15/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 PD02128433335 23/02/2<strong>01</strong>2 PD <strong>03</strong>02-Aqn/202 Kepala Balai Besar Wilayah Sungai Serayu - Opak 13/<strong>03</strong>/12 26‐3‐2<strong>01</strong>2 02<strong>01</strong>290047633336 24/02/2<strong>01</strong>2 KET-175/BL.<strong>01</strong>/UP.06/2<strong>01</strong>2Sekretaris Badan Pengawas Pasar Modal dan LembagaKeuangan Sekretariat Badan16/<strong>03</strong>/12 26‐3‐2<strong>01</strong>2 02<strong>01</strong>29004767Hal 167

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3337 24/02/2<strong>01</strong>2 520.13/146-BP4K/2<strong>01</strong>2Kepala Badan Pelaksana Penyuluhan Pertanian,Perikanan dan Kehutanan Kabupaten Pandeglang15/<strong>03</strong>/12 26‐3‐2<strong>01</strong>2 PD02086663338 24/02/2<strong>01</strong>2 486/UN44/LL/2<strong>01</strong>2 Pembantu Rektor Bid. Akademik Unversitas Khairun 15/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD02086673339 24/02/2<strong>01</strong>2 800/327/Sekret/DPK/2<strong>01</strong>23340 27/02/2<strong>01</strong>2 <strong>03</strong>/DIKLAT/II/2<strong>01</strong>23341 27/02/2<strong>01</strong>2 -Kepala Dinas Perikanan dan Kelautan KabupatenTabananKepala Balai Diklat Badan Kepegawaian dan PelatihanProvinsi Kepulauan RiauKepala Dinas Bina Marga dan Cipta Karya Kab.Majalengka13/<strong>03</strong>/12 26-3-2<strong>01</strong>2 02<strong>01</strong>2900476513/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD020866413/<strong>03</strong>/12 22-3-2<strong>01</strong>2 PD02128413342 27/02/2<strong>01</strong>2 <strong>027</strong>/160/412.19/2<strong>01</strong>2 Kepala Bagian Perlengkapan Pemkab. Bojonegoro 13/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD02086653343 27/02/2<strong>01</strong>2 028/644 Kepala Dinas Kesehatan Kabupaten Gunungkidul 13/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD021281<strong>03</strong>344 27/02/2<strong>01</strong>2 <strong>027</strong>/500Sekretaris BPAD Pemerintah Propinsi Daerah istimewaYogyakarta19/<strong>03</strong>/12 26-3-2<strong>01</strong>2 02<strong>01</strong>290046273345 27/02/2<strong>01</strong>2 558/24/II/2<strong>01</strong>2 Kepala Bappeda Kab. Bombana 19/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD02128053346 27/02/2<strong>01</strong>2 <strong>027</strong>/296/2612Kepala Dinas Pendapatan Keuangan Dan Asset Kab.Padang Lawas21/<strong>03</strong>/12 02<strong>01</strong>29004797 Sertifikat masih berlaku3347 28/02/2<strong>01</strong>2 800/169/2<strong>01</strong>2Sekretaris Dinas Pengairan Dan Energi Sumber DayaMineral Kab. Aceh Utara21/<strong>03</strong>/12 PD0212591Tidak ada surat permohonankonversi3348 23/02/2<strong>01</strong>2 B/208-08/05/131/Babek Wakil Kepala Badan Pembekalan TNI 16/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>2900477<strong>03</strong>349 24/02/2<strong>01</strong>2 <strong>027</strong>/306/B3350 24/02/2<strong>01</strong>2 KW.23.3/PP.00/647/2<strong>01</strong>2Kepala Pelaksana BPBD Provinsi Daerah IstimewaYogyakartaKepala Bidang Mapenda Kantor Wilayah ProvinsiSulaewsi Utara16/<strong>03</strong>/12 21‐3‐2<strong>01</strong>2 02<strong>01</strong>2900477116/<strong>03</strong>/12 26/<strong>03</strong>/12 PD02086633351 24/02/2<strong>01</strong>2 <strong>03</strong>1/PL 11.1.8/DIN/KP/2.2<strong>01</strong>2 Direktur Politeknik Manufaktur Negeri Bandung 16/<strong>03</strong>/12 26‐3‐2<strong>01</strong>2 02<strong>01</strong>290047373352 28/02/2<strong>01</strong>2 524/161/DisnakkanKepala Dinas Peternakan Perikanan Darat KabupatenBangli21/<strong>03</strong>/12 02<strong>01</strong>29004798Tidak ada SosialisasiPerpres 54Hal 168

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3353 29/02/2<strong>01</strong>2 552/308/2<strong>01</strong>2Kepala Dinas Kehutanan Dan Perkebunan Kab. AcehTamiang22/<strong>03</strong>/12 PD0212604Sertifikat masih berlaku,dan tidak ada sosialisasiPerpres 543354 29/02/2<strong>01</strong>2 800/170.A Kepala Dinas Pekerjaan Umum Kota Surakarta 22/<strong>03</strong>/12 02<strong>01</strong>29004787 Sertifikat masih berlaku3355 29/02/2<strong>01</strong>2 800/110.13/BRSUD Kepala Badan RSUD Kab. Buol 22/<strong>03</strong>/12 PD0212605 Sertifikat masih berlaku3356 29/02/2<strong>01</strong>2 <strong>027</strong>/50/Itkab/2<strong>01</strong>2 Inspektur Kabupaten Bangli 21/<strong>03</strong>/12 PD0212599Tidak ada SosialisasiPerpres 543357 29/02/2<strong>01</strong>2 600/293/DCKTK.1/II/2<strong>01</strong>2Plh. Kepala Dinas Cipta Karya Dan Tata Kota Pemkot.Samarinda21/<strong>03</strong>/12 PD0212598Tidak melampirkan FCSertifikat3358 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/0441/SETWAN/2<strong>01</strong>2Kepala Bagian umum SETWAN DPRD Pemkab.Banyuasin21/<strong>03</strong>/12 PD0212597 Sertifikat masih berlaku3359 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 892.3/106/Setwan Sekretaris DPRD Kabupaten Bangli 21/<strong>03</strong>/12 PD02125963360 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 /UM‐PLK/II/2<strong>01</strong>2 Kepala Biro Umum Kementerian Sosial RI 21/<strong>03</strong>/12 PD0212593Tidak ada SosialisasiPerpres 54Tidak ada SosialisasiPerpres 543361 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 050/199/430.11.1/2<strong>01</strong>2 Inspektur Kabupaten Bondowoso 21/<strong>03</strong>/12 PD0212595 Sertifikat masih berlaku3362 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 18.24.523.3/439/2<strong>01</strong>2Kepala Dinas Perikanan Dan Kelautan Kab. SerdangBerdagai21/<strong>03</strong>/12 PD0212592Tidak ada SosialisasiPerpres 543363 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 600/36/DPU/2<strong>01</strong>2Kepala Dinas Pekerjaan Umum Pemkab. Hulu SungaiUtara21/<strong>03</strong>/12 PD0212594Tidak ada SosialisasiPerpres 543364 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 893.3/BM‐SDA/2<strong>01</strong>2/82Kepala Dinas Bina Marga Dan Sumber Daya Air Kab.Pelalawan21/<strong>03</strong>/12 PD.0212585 Sertifikat masih berlaku3365 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 050/181/BAP/V/2<strong>01</strong>1 Wakil Walikota Bima 21/<strong>03</strong>/12 02<strong>01</strong>29004795 Sudah lulus ujian3366 05/<strong>03</strong>/2<strong>01</strong>2 B‐277/N.9.10/Cu.3/02/2<strong>01</strong>2 Kepala kejaksaan Negeri Pangkalanpinang 22/<strong>03</strong>/12 02<strong>01</strong>29004786 Sertifikat masih berlaku3367 05/<strong>03</strong>/2<strong>01</strong>2 B/59/10000/II/2<strong>01</strong>2 Direktur Utama PAL Indonesia 22/<strong>03</strong>/12 02<strong>01</strong>29004788 Sertifikat masih berlaku3368 05/<strong>03</strong>/2<strong>01</strong>2 UM‐17/IPR/BMKG‐2<strong>01</strong>12 Inpektur Inspektorat BMKG 22/<strong>03</strong>/12 PD0212602 Sertifikat masih berlaku3369 06/<strong>03</strong>/2<strong>01</strong>2 41/RO.4/R/KPEK/II/2<strong>01</strong>2 Kepala Biro Kerjasama Luar Negeri 21/<strong>03</strong>/12 02<strong>01</strong>29004799 Sertifikat masih berlakuHal 169

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3370 06/<strong>03</strong>/2<strong>01</strong>2 9<strong>03</strong>/222/Dinkes/2<strong>01</strong>2 Sekretaris Dinas Kesehatan Pemkab. Padang Pariaman 28/<strong>03</strong>/12 29/<strong>03</strong>/12 PD0212750Tidak melampirkan FCSertifikat3371 21/02/2<strong>01</strong>2 104/PL.18/TU/2<strong>01</strong>2 Direktur Politeknik Negeri Banjarmasin 20/<strong>03</strong>/12 22‐3‐2<strong>01</strong>2 PD021285<strong>03</strong>372 21/02/2<strong>01</strong>2 893.4/539/2<strong>01</strong>23373 22/02/2<strong>01</strong>2 IK.<strong>01</strong>.06/AW /50Kepala Dinas Perindustrian Perdagangan Koperasi danUsaha Kecil Menengah Pem. AcehKepala Balai Besar Wilayah Sungai MesujiSekampungProses 22‐3‐2<strong>01</strong>2 PD0212676Proses 26‐3‐2<strong>01</strong>2 PD02086683374 24/02/2<strong>01</strong>2 S-0439/DKP-1.1/II/2<strong>01</strong>2 Kepala Dinas Kelautan Dan Perikanan Provinsi Jambi Proses 21/<strong>03</strong>/12 PD02128423375 27/02/2<strong>01</strong>2 428/0<strong>03</strong>8/426.1<strong>01</strong>.SMKN2/2<strong>01</strong>2 Kepala SMK Negeri 2 Kraksaan Pemkab.Probolingo 21/<strong>03</strong>/12 02<strong>01</strong>29004796Tidak ada sosialisasiPerpres 543376 27/02/2<strong>01</strong>2 556/37/WSTKepala Dinas Kebudayaan Dan Pariwisata Pemkab.Lombok Tengah21/<strong>03</strong>/12 PD0212590Tidak melampirkan FCSertifikat3377 27/02/2<strong>01</strong>2 800/DPU-PHWT/21.a/II/2<strong>01</strong>2 Kepala Dinas Pekerjaan Umum Pemkab. Pohuwato 15/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD02128093378 27/02/2<strong>01</strong>2 <strong>03</strong>/LPPN/II/2<strong>01</strong>2Direktur Program Lembaga PengembanganPengetahuan Nusantara16/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD02128293379 24/02/2<strong>01</strong>2 S-1095/PW.<strong>03</strong>/2/2<strong>01</strong>2 Plh Kepala BPKP Perwakilan Prov. Sumatera Barat 13/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD02128113380 24/02/2<strong>01</strong>2 Blt.<strong>03</strong>/HM.<strong>01</strong>/125/2<strong>01</strong>2 Kepala Balai Penelitian Dan Pengembangan Agama 15/<strong>03</strong>/12 26-3-2<strong>01</strong>2 PD02128283381 07/02/2<strong>01</strong>2 <strong>01</strong>2/UN45.7/LL/2<strong>01</strong>2 Ketua LPKM Universitas Malikussaleh 16/<strong>03</strong>/12 27‐3‐2<strong>01</strong>2 PD02128233382 17/02/2<strong>01</strong>2 521.1/2822/Sekr/II/2<strong>01</strong>2 Dinas Pertanian Pemprov. Sumatera Utara 15/<strong>03</strong>/12 27‐3‐2<strong>01</strong>2 02<strong>01</strong>290046253383 24/02/2<strong>01</strong>2 <strong>027</strong>/252-PK/2<strong>01</strong>1 Sekretaris Daerah Kota Cirebon 15/<strong>03</strong>/12 28-3-2<strong>01</strong>2 02<strong>01</strong>290046293384 27/02/2<strong>01</strong>2 893.4/02/2<strong>01</strong>2 Setda. Pemkot. Ternate 16/<strong>03</strong>/12 27-3-2<strong>01</strong>2 PD02128223385 27/02/2<strong>01</strong>2 890.891/DPU.KAB.DGLA/II/209/2<strong>01</strong>2Kepala Dinas Pekerjaan Umum Kabupaten Donggala 19/<strong>03</strong>/12 27-3-2<strong>01</strong>2 PD02128153386 27/02/2<strong>01</strong>2 620/126/DPU.KAB-SEKR. Kepala Dinas Pekerjaan Umum Kab. Tabanan 19/<strong>03</strong>/12 27-3-2<strong>01</strong>2 02<strong>01</strong>29004628Hal 170

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3387 27/02/2<strong>01</strong>2 440/050-3<strong>03</strong>/Sek/II/2<strong>01</strong>2 Kepala Dinas Kesehatan Kab. Donggala 19/<strong>03</strong>/12 27-3-2<strong>01</strong>2 PD02126653388 27/02/2<strong>01</strong>2 870/179/DS/II/2<strong>01</strong>2 Kepala Dinas Sosial Provinsi Kalimantan Barat 19/<strong>03</strong>/12 27-3-2<strong>01</strong>2 PD021268<strong>03</strong>389 28/02/2<strong>01</strong>2 <strong>027</strong>/296/2612 Kepala Bagian Pembangunan Setda Gorontalo Utara 19/<strong>03</strong>/12 28-3-2<strong>01</strong>2 PD021280<strong>03</strong>390 28/02/2<strong>01</strong>2 9<strong>03</strong>/2/6/Dinkes/2<strong>01</strong>2 Kepala Dinas Kesehatan Kab. Padang Pariaman 19/<strong>03</strong>/12 27-3-2<strong>01</strong>2 PD02128073391 28/02/2<strong>01</strong>2 045.2/08.078/BPBD/2<strong>01</strong>2 Kepala Pelaksana BPBD Pemkab. Donggala 19/<strong>03</strong>/12 27-3-2<strong>01</strong>2 PD02128253392 28/02/2<strong>01</strong>2 <strong>027</strong>/0053393 28/02/2<strong>01</strong>2 W7.EN.KP.07.<strong>01</strong>.090Plt. Asisten ekonomi, pembangunan dan KesejahteraanSosial Pemkot. TegalKepala Rumah Penyimpanan Benda Sitaan NegaraKelas I Jakarta Pusat19/<strong>03</strong>/12 27-3-2<strong>01</strong>2 PD021268119/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 02<strong>01</strong>290046123394 28/02/2<strong>01</strong>2 602/710‐Pemb Sekretaris Daerah Setda Pemkab Bogor 19/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 02<strong>01</strong>290046133395 02/<strong>03</strong>/2<strong>01</strong>2 Kd.31.05/KP.02.3/160/2<strong>01</strong>0kepala Kementrian Agama RI Kantor Kab. MamujuUtara20/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 PD02127813396 02/<strong>03</strong>/2<strong>01</strong>2 UM.002/82/1/BSM/2<strong>01</strong>1 Kepala Bandar Udara Sugimanuru Muna 20/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 PD02128<strong>03</strong>3397 23/02/2<strong>01</strong>2 800/05/349 Sekretaris Daerah u.b Asisten Pemerintahan 16/<strong>03</strong>/12 27‐3‐2<strong>01</strong>2 PD02128263398 23/02/2<strong>01</strong>2 <strong>027</strong>/611/AKP.Aset3399 23/02/2<strong>01</strong>2 024.2/<strong>027</strong>113400 24/02/2<strong>01</strong>2 <strong>027</strong>/270/Hubkominfo/2<strong>01</strong>2Asisten Administrasi Umum Kepala Biro AsetSekretariat Daerah Provinsi BaliSekretaris Badan Perencanaan Pembangunan DaerahSemarangKepala Dinas Perhubungan Komunikasi danInformatika Kabupaten Jembrana16/<strong>03</strong>/12 27‐3‐2<strong>01</strong>2 02<strong>01</strong>2900462416/<strong>03</strong>/12 27‐3‐2<strong>01</strong>2 02<strong>01</strong>2900462616/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 02<strong>01</strong>2900461434<strong>01</strong> 24/02/2<strong>01</strong>2 260/PPS.2/PL.420/II/2<strong>01</strong>2 Kepala Pelabuhan Perikanan Samudera Kendari 28-3-2<strong>01</strong>2 PD021278<strong>03</strong>402 06/<strong>03</strong>/2<strong>01</strong>2 W2‐A11/106/KP.<strong>01</strong>.3/II/2<strong>01</strong>2 Ketua Pengadilan Agama Kisaran 22/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD0212771Hal 171

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>34<strong>03</strong> 28/02/2<strong>01</strong>2 Bdl.08/KP.02.3/126/2<strong>01</strong>23404 29/02/2<strong>01</strong>2 S.102/VI/BPPHP‐V/1/2<strong>01</strong>2Plh. Kepala Balai pendidikan Dan Pelatihan KeagamaanBanjarmasinPlt. Kepala Balai Pemantauan Pemanfaatan HutanProduksi Wilayah V22/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD021276322/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02127573405 29/02/2<strong>01</strong>2 523/III/Nakkan/2<strong>01</strong>2 Kepala Dinas Peternakan Dan Perikanan Kab. Ogan Ilir 26/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02127623406 29/02/2<strong>01</strong>2 27.5/17.0/TU.230/II/2<strong>01</strong>2Kepala Balai karantina Ikan, Pengendalian Mutu DanKeamanan Hasil Perikanan Kelas II SemarangProses 30‐3‐2<strong>01</strong>2 02<strong>01</strong>290047<strong>03</strong>3407 29/02/2<strong>01</strong>2 S‐68/WPJ.22/KP.<strong>01</strong><strong>01</strong>/2<strong>01</strong>2 Kepala Kantor Pelayanan Pajak Pratama Bekasi Utara 26/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 02<strong>01</strong>290047063408 29/02/2<strong>01</strong>2 892.3/237/Adm.Pemb. Sekretaris Daerah Kab. Bangli 26/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 02<strong>01</strong>290047053409 29/02/2<strong>01</strong>2 524/35/Nakeswan/II/2<strong>01</strong>2Kepala Dinas Peternakan Dan Kesehatan HewanPemkab. Boalemo26/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 PD02127393410 29/02/2<strong>01</strong>2 <strong>027</strong>/196‐Pemb Sekretaris Daerah kota Depok 28/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 02<strong>01</strong>290047423411 29/02/2<strong>01</strong>2 Un.05/V.8/OT.<strong>01</strong>.7/2/2<strong>01</strong>2Ketua Universitas Islam Negeri Sunan Gunung DjatiBandung26/<strong>03</strong>/12 04‐4=2<strong>01</strong>2 02<strong>01</strong>290046543412 29/02/2<strong>01</strong>2 Kd.22.10/<strong>01</strong>/Kp.00/74/2<strong>01</strong>2 Kepala Kantor Kab. Tojo Una‐Una Kementrian Agama 26/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02157193413 29/02/2<strong>01</strong>2 560/S4/Disnaker/I/2<strong>01</strong>2 Kepala Dinas Tenga Kerja Kab. Bekasi 22/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 02<strong>01</strong>290047163414 29/02/2<strong>01</strong>2 SM.10F/1/4/DNG‐ABN‐123415 29/02/2<strong>01</strong>2 Kw.22.1/1/KU.00.2/441/2<strong>01</strong>23416 29/02/2<strong>01</strong>2 800/I.1‐465/BKD/1/2<strong>01</strong>2Kepala Distrik Navigasi Kelas I Ambon Selaku KuasaPengguna Anggaran/Pejabat Pembuat KomitmenKepala Kantor Wilayah Propinsi Sulawesi TengahKementrian AgamaKepala Badan Kepagawaian Daerah Pemkab. KutaiKartanegara22/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD021574826/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD021271622/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02127263417 29/02/2<strong>01</strong>2 <strong>027</strong>/131/Disdik Kepala Dinas Pendidikan Kab. Sukabumi 28/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD021567<strong>03</strong>418 29/02/2<strong>01</strong>2 <strong>027</strong>/436/PEG UM Sekretaris Dinas Sosial Provinsi Jawa Barat 26/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 02<strong>01</strong>29004712Hal 172

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3419 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 1223/PL.430.SI/II/2<strong>01</strong>2 Sekretatis Ditjen Perikanan Tangkap 27/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 02<strong>01</strong>290047023420 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 800/233/Pertanak‐Sekret/2<strong>01</strong>23421 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 UM <strong>03</strong> 02/Ab‐II/733422 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 055/649/416‐021/2<strong>01</strong>2Kepala Dinas Pertanian dan Peternakan Pemkab.BanyuasinDirektur Direktorat Bina Penatagunaan Sumber DayaAirAsisten Perekonomian Dan Pembangunan Setda.Pemkab Mojokerto21/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD021268321/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 02<strong>01</strong>2900470721/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 PD02127<strong>03</strong>3423 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 893,3/14/HMS/II/2<strong>01</strong>2 Sekretaris DPRD Provinsi Kaltim 21/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 PD02127773424 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 W14‐A/388/PP.00.4/II/2<strong>01</strong>2Panitera / Sekretaris Pengadilan Tinggi AgamaPontianak26/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 PD02127383425 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 344/SJ.3/KOMINFO/3/2<strong>01</strong>2 Kepala Biro keuangan Kementrian KOMINFO RI 21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 02<strong>01</strong>290047383426 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 48/DBM‐SDA/II/2<strong>01</strong>23427 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 800/544/TUKepala Dinas Bina Marga dan Sumber Daya AirPemkab. Kutai KartanegaraKepala Dinas Peternakan, Perikanan dan Kelautan Kab.Bekasi21/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD021577728/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 02<strong>01</strong>290046563428 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 890/PU‐UPTJKSDM/526 Sekretaris Dinas Pekerjaan Umum Provinsi Riau 28/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02157333429 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/138/419.44/2<strong>01</strong>2Plt. Kepala Dinas Pendapatan Keuangan dan AssetKota Kediri26/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02127153430 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/392/Kepegum Kepala Bappeda. Provinsi Jawa Barat 28/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02157433431 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/569Sekretaris Dinas Pariwisata Provinsi Daerah istimewaYogyakarta26/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 02<strong>01</strong>290047143432 02/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/27/BHP‐SR/II/2<strong>01</strong>2 Sekretaris Daerah Setda. Pemkab. Sabu Raijua 20/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 PD02128043433 02/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/45/Perl.2 Sekretaris Daerah Setda. Pemkab. Kutai Timur 20/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 PD02128023434 02/<strong>03</strong>/2<strong>01</strong>2 600/27/ PU. BMP/2<strong>01</strong>2 Sekretaris Daerah Setda. Pemkab. Lahat 20/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 PD0212779Hal 173

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3435 02/<strong>03</strong>/2<strong>01</strong>2 028/<strong>03</strong>76‐umpeg/Diskanlut3436 02/<strong>03</strong>/2<strong>01</strong>2 ‐3437 05/<strong>03</strong>/2<strong>01</strong>2 Um<strong>01</strong>.11/Br.S2/4733438 05/<strong>03</strong>/2<strong>01</strong>2 Kw.09.1/2/KU.00/1<strong>03</strong>7/2<strong>01</strong>2Kepala Dinas Perikanan dan Kelautan ProvinsiKalimantan SelatanKasubag Tata Usaha Dirjen. Sumber Daya Air BalaiWilayah Sungai Maluku UtaraKepala Satker Pelaksanaan Jalan Nasional Wilayah IProv. Sumatera UtaraKepala Kementrian Agama kantor Wilayah ProvinsiDKI. Jakarta20/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 PD021267521/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 PD021274129/<strong>03</strong>/12 02<strong>01</strong>29004793 Sertifikat masih berlaku20/<strong>03</strong>/12 28‐3‐2<strong>01</strong>2 02<strong>01</strong>290046093439 05/<strong>03</strong>/2<strong>01</strong>2 600/223/PUK/I/2<strong>01</strong>2 Kepala Dinas Pekerjaan Umum Kab. Tapanuli Tengah 21/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02126843440 05/<strong>03</strong>/2<strong>01</strong>2 800/125/II/2<strong>01</strong>23441 05/<strong>03</strong>/2<strong>01</strong>2 800/750/BPM3442 05/<strong>03</strong>/2<strong>01</strong>2 800/117/KKB‐LINMAS/2<strong>01</strong>23443 05/<strong>03</strong>/2<strong>01</strong>2 800/174/WB/2<strong>01</strong>2Sekretaris Dinas Pekerjaan Umum Pemkot.LhokseumaweSekretaris Badan Pemberdayaan MasyarakatPemerintah AcehKepala Kantor Kesatuan Bangsa, Politik DanPerlindungan Masyarakat Kab. Tapanuli SelatanKepala UPT PSDA Provinsi Wampu Besitang Pemprov.Sumatera Utara22/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 PD021277022/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD021277522/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD021277421/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 PD02127833444 05/<strong>03</strong>/2<strong>01</strong>2 429/D.3/775/2<strong>01</strong>2 Kepala Dinas Pendidikan kab. Aceh Tamiang 21/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 PD02127823445 05/<strong>03</strong>/2<strong>01</strong>2 800/SEKR/182/2<strong>01</strong>23446 05/<strong>03</strong>/2<strong>01</strong>2 800/9095/2<strong>01</strong>1Kepala Dinas Pasar, Kebersihan Dan Pertamanan Kab.BengkalisSekretaris Daerah Kabupaten Pemkab. TapanuliSelatan21/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 PD021278421/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 PD02127853447 05/<strong>03</strong>/2<strong>01</strong>2 056/020/2<strong>01</strong>2 Kepala Dinas Pekerjaan Umum Kab. Aceh Selatan 21/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 PD02126743448 05/<strong>03</strong>/2<strong>01</strong>2 556/<strong>03</strong>7/Bupdar/2<strong>01</strong>2Kepala Dinas Kebudayaan Dan Pariwisata kab. TobaSamosir21/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 PD02126863449 05/<strong>03</strong>/2<strong>01</strong>2 800/0048/PUK/2<strong>01</strong>2 Kepala Dinas PU Kab. Tapanuli Utara 21/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02126873450 05/<strong>03</strong>/2<strong>01</strong>2 893.3/67/P2TSP/2<strong>01</strong>13451 05/<strong>03</strong>/2<strong>01</strong>2 800/185/BKPP/2<strong>01</strong>2Kepala Kantor Pelayanan Perizinan Terpadu Satu PintuKab. Aceh SingkilKepala Badan Kepegawaian, Pendidikan Dan PelatihanKab. Musi Rawas21/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD021276022/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02127563452 05/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/<strong>03</strong>189/SET Kepala DPPKA Pemprov. Daerah Istimewa Yogyakarta 22/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD0212755Hal 174

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3453 05/<strong>03</strong>/2<strong>01</strong>2 890/042/DBP‐set/I/2<strong>01</strong>2Kepala Dinas Bina Marga Dan Pengairan Kab. LubuRaya22/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02127723454 05/<strong>03</strong>/2<strong>01</strong>2 900/0294 Kepala Dinas Kesehatan Kab. Buton 29/<strong>03</strong>/12 PD0212615<strong>No</strong>n sosialisasi, Sudah lulusujian3455 05/<strong>03</strong>/2<strong>01</strong>2 W10.E49.PL.02.<strong>03</strong>‐75Kepala Rumah Penyimpanan Benda Sitaan NegaraKelas III Probolinggo29/<strong>03</strong>/12 02<strong>01</strong>29004791 Sertifikat masih berlaku3456 05/<strong>03</strong>/2<strong>01</strong>2 466/D6/ULP.III/2<strong>01</strong>2 Ketua Unit Layanan Pengadaan III Pemkab. Pontianak 29/<strong>03</strong>/12 PD0212616 Sertifikat masih berlaku3457 05/<strong>03</strong>/2<strong>01</strong>2 0523/B‐3/BPD‐PST/II/2<strong>01</strong>2Direktur Umum Bank Pembangunan Daerah KalimatanTimur29/<strong>03</strong>/12 PD02126173458 05/<strong>03</strong>/2<strong>01</strong>2 S‐93/WBC.O2/2<strong>01</strong>2 Kepala Kantor Dirjen. Bea Dan Cukai Sumatera Utara 29/<strong>03</strong>/12 02<strong>01</strong>290047923459 05/<strong>03</strong>/2<strong>01</strong>2 ‐3460 05/<strong>03</strong>/2<strong>01</strong>2 175/PL.<strong>01</strong>0/L.36.C/2/2<strong>01</strong>2Kepala Dinas Perikanan Dan Kelautan Pemkab.Tapanuli SelatanPejabat Pembuat Komitmen Balai Karantina Pertaniankelas II MedanTidak melampirkan FCSertifikatTidak melampirkan FCSertifikat29/<strong>03</strong>/12 PD0212749 Sertifikat masih berlaku29/<strong>03</strong>/12 PD0212751 Sertifikat masih berlaku3461 05/<strong>03</strong>/2<strong>01</strong>2 810/175/2<strong>01</strong>2 Kepala Dinas Pendidikan Pemkab. Aceh Singkil 29/<strong>03</strong>/12 PD0212618 Sertifikat masih berlaku3462 05/<strong>03</strong>/2<strong>01</strong>2 094/008/2<strong>01</strong>2 Camat Padangsidimpuan Tenggara 29/<strong>03</strong>/12 PD0212619 Sertifikat masih berlaku3463 05/<strong>03</strong>/2<strong>01</strong>2 550/100.a/Dishubkominfo/2<strong>01</strong>2 Sekretaris Dishubkominfo pemkab. Nias Selatan 29/<strong>03</strong>/12 PD0212620 Sertifikat masih berlaku3464 05/<strong>03</strong>/2<strong>01</strong>2 600/164/PU/2<strong>01</strong>2 Kepala Dinas Pekerjaan Umum Kab. Nias Barat 29/<strong>03</strong>/12 PD0212621 Sertifikat masih berlaku3465 05/<strong>03</strong>/2<strong>01</strong>2 054/K1.1.2/KU/2<strong>01</strong>2Koordinator Koordinasi Perguruan Tinggi SwastaWilayah I29/<strong>03</strong>/12 02<strong>01</strong>29004794Sudah pernah mengajukankonversi3466 05/<strong>03</strong>/2<strong>01</strong>2 445/004/RSUD‐LBU/II/2<strong>01</strong>2 Direktur RSUD Kab. Labuhanbatu Utara 29/<strong>03</strong>/12 02<strong>01</strong>29004610 Sertifikat masih berlaku3467 05/<strong>03</strong>/2<strong>01</strong>2 KT.267/BDK‐2/2<strong>01</strong>2Kepala Balai Pendidikan Dan Pelatihan KehutananPematang Siantar29/<strong>03</strong>/12 02<strong>01</strong>29004608 Sertifikat masih berlaku3468 05/<strong>03</strong>/2<strong>01</strong>2 090/36/II/2<strong>01</strong>2/Disbun Kepala Dinas Perkebunan Pemkab. Mamuju Utara 29/<strong>03</strong>/12 PD0212622Sertifikat masih berlaku dantidak melampirkan FCSertifikat3469 05/<strong>03</strong>/2<strong>01</strong>2 451/52/J/2<strong>01</strong>2 Plt. Kepala Dinas Syari'at Islam Kota Subulussalam 02/04/12 PD0212702 Sertifikat masih berlaku3470 05/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/ /EKBANG/2<strong>01</strong>2 Sekretaris Daerah Kab. Nias Barat Sertifikat masih berlakuHal 175

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3471 05/<strong>03</strong>/2<strong>01</strong>2 870/278/TU‐TRP/2<strong>01</strong>2Kepala Dinas Tata Ruang dan Pemukiman Pemkab.Toba Samosir02/04/12 PD0212764 Sertifikat masih berlaku3472 05/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/0871/Adpem/2<strong>01</strong>2 Sekretaris Daerah Pemkab. Sumedang 22/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02157893473 05/<strong>03</strong>/2<strong>01</strong>2 KU.<strong>01</strong>.02/Br.A2/0542Kepala Satuan Kerja Pela. Acehksanaan Jaln nasionalWilayah I Prov. Aceh21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02127343474 05/<strong>03</strong>/2<strong>01</strong>2 360/37/BPBD/2<strong>01</strong>2 Sekretaris BPBD Pemkab. Nias 21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02127353475 05/<strong>03</strong>/2<strong>01</strong>2 <strong>01</strong>/PPAMaRi/I/2<strong>01</strong>2Ketua Pusat Pengembangan Akuntansi DanManajemen Risiko Univ. Syiah Kuala27/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02157833476 05/<strong>03</strong>/2<strong>01</strong>2 KT.332/BBTNGL‐1/2<strong>01</strong>2 Kepala Balai besar Taman nasioanal Gunung Leuser 21/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02157163477 05/<strong>03</strong>/2<strong>01</strong>2 B.160/BBPLKLN/II/2<strong>01</strong>23478 05/<strong>03</strong>/2<strong>01</strong>2 061/BPPT/II/2<strong>01</strong>2/10Kepala Balai Besar Pengembangan Pelatihan Kerja LuarNegeriKepala Badan Pelayanan Perizinan Terpadu Kab.Bengkalis21/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02158<strong>03</strong>21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02157563479 05/<strong>03</strong>/2<strong>01</strong>2 600/206 Kepala Dinas Pekerjaan Umum Kota Tanjungbalai 21/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02157463480 05/<strong>03</strong>/2<strong>01</strong>2 W.1.U14/282/Kp.05/II/2<strong>01</strong>2 Ketua Pengadilan Negeri Kualasimpang 21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02157843481 05/<strong>03</strong>/2<strong>01</strong>2 540/DISTAMEN/.25 Kepala Dinas Pertambangan Dan Energi Kab. Lingga 22/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02127513482 05/<strong>03</strong>/2<strong>01</strong>2 525/425/DKhP‐II/2<strong>01</strong>2Kepala Dinas Kehutanan dan Perkebunan Kab.Simeulue26/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD021575<strong>03</strong>483 05/<strong>03</strong>/2<strong>01</strong>2 ‐ PT. Bank Sumut 26/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD021271<strong>03</strong>484 05/<strong>03</strong>/2<strong>01</strong>2 67/KLH‐TU/2<strong>01</strong>1 Kepala kantor Lingkungan Hidup kab. Tapanuli Utara 21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02157743485 05/<strong>03</strong>/2<strong>01</strong>2 820/3065/2<strong>01</strong>1 Kepala Dinas Kesehatan Kab. Bireuen 21/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02157493486 05/<strong>03</strong>/2<strong>01</strong>2 893.3/164/2<strong>01</strong>2Kepala Dinas Kehutanan Dan Perkebunan Pemkab.Aceh Singkil22/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02157573487 05/<strong>03</strong>/2<strong>01</strong>2 734/‐084 Kepala Dinas Sosial Provinsi DKI Jakarta 21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 02<strong>01</strong>290047093488 05/<strong>03</strong>/2<strong>01</strong>2 In.07/B.1b/Kp. / /2<strong>01</strong>23489 05/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/066.‐DBMPKetua Pelaksana Institut Agama Islam Negeri SumateraUtaraKepala Dinas Bina Marga Dan Pengairan Pemkot.Bandung21/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD021578221/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 02<strong>01</strong>29004717Hal 176

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3490 06/<strong>03</strong>/2<strong>01</strong>2 392.S/204/BLH/2<strong>01</strong>2 Kepala Badan Lingkungan Hidup Kab. Bangli 22/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 02<strong>01</strong>290047363491 06/<strong>03</strong>/2<strong>01</strong>2 9<strong>03</strong>/229/Dinkes/2<strong>01</strong>2 Kepala Dinas Kesehatan Kab. Padang Pariaman 22/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02127593492 06/<strong>03</strong>/2<strong>01</strong>2 B/63/II/2<strong>01</strong>2Kepala Balurjalbar Badan Penyalur Tenaga KerjaWiayah Barat22/<strong>03</strong>/12 29‐3‐2<strong>01</strong>2 02<strong>01</strong>290047043493 06/<strong>03</strong>/2<strong>01</strong>2 S‐674/WPJ.32/KP.07/2<strong>01</strong>2 Kepala Kantor Pelayanan Pajak Pratama Karanganyar 29/<strong>03</strong>/12 02<strong>01</strong>29004611Sertifikat masih berlaku dantidak melampirkanSosialisasi Perpres 543494 06/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/2100Kasubag Tata Usaha Balai Pengobatan Penyakit Paru‐Paru Yogyakarta02/04/12 PD0212766<strong>No</strong>n sosialisasi, Sudahpernah dikonversi3495 06/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/<strong>01</strong><strong>03</strong>‐BPPKB/2<strong>01</strong>2 Kepala BPPKB Pemkab. Bandung 02/04/12 PD0212776 Sertifikat masih berlaku3496 06/<strong>03</strong>/2<strong>01</strong>2 551/100/Dishub Kominfo/2<strong>01</strong>2 Kepala Dishub Kominfo Pemkab. Bangli 02/04/12 PD0212765 <strong>No</strong>n sosialisasi3497 06/<strong>03</strong>/2<strong>01</strong>2 Sti.21/1/KS.00/504/2<strong>01</strong>2 Ketua Sekolah Tinggi Agama Islam Negeri Ponorogo 22/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD021576<strong>03</strong>498 06/<strong>03</strong>/2<strong>01</strong>2 W-24-U/370/KP.10.10/III/2<strong>01</strong>2 Wakil Sekretaris Pengadilan Tinggi Denpasar 19/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 PD02157733499 06/<strong>03</strong>/2<strong>01</strong>2 658/1<strong>03</strong>‐DKK/II/2<strong>01</strong>23500 06/<strong>03</strong>/2<strong>01</strong>2 KU.002/1/1/UPP.Nbr‐2<strong>01</strong>2Kepala Dinas Kebersihan dan Kebakaran Pemkot.PangkalpinangKepala Kantor Unit Penyelenggara Pelabuhan Kelas IIINabire29/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 02<strong>01</strong>2900474326/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD021573235<strong>01</strong> 06/<strong>03</strong>/2<strong>01</strong>2 523/45A/II/2<strong>01</strong>2 Kepala Dinas Kelautan dan Perikanan Pemkab Luwu 28/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02156863502 06/<strong>03</strong>/2<strong>01</strong>2 W22.U6/WTP/120/UM/<strong>01</strong>.10/II/2<strong>01</strong>2 Panitera/Sekretaris Pengadilan Negeri Watampone 22/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD021573<strong>03</strong>5<strong>03</strong> 07/<strong>03</strong>/2<strong>01</strong>2 W33.PAS.02‐PL.02.<strong>03</strong>‐129 Kepala Lembaga Pemasyarakatan kelas IIB Sorong 27/<strong>03</strong>/12 PD0212612 Sertifikat masih berlaku3504 07/<strong>03</strong>/2<strong>01</strong>2 800/510/RSUD‐TT/2<strong>01</strong>2Plt. Direktur RSUD DR. H. Kumpulan Pane Kota TebingTinggi27/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 PD0212737Hal 177

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3505 07/<strong>03</strong>/2<strong>01</strong>2 B/916/III/2<strong>01</strong>2/Bareskrim Kaporenmin Mabes Kepolisian Negara RI 27/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 02<strong>01</strong>290046493506 07/<strong>03</strong>/2<strong>01</strong>2 W26‐A/389/PL.05/II/2<strong>01</strong>2 Ketua Pengadilan Tinggi Agama Gorontalo 27/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02127133507 07/<strong>03</strong>/2<strong>01</strong>2 050/54/441.122/2<strong>01</strong>2 Plt. Sekretaris Daerah Kab. Pamekasan 29/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02156743508 08/<strong>03</strong>/2<strong>01</strong>2 B‐47/Setneg/PPKK/KU/<strong>03</strong>/2<strong>01</strong>2 Plt. Direktur Keuangan dan Umum Sekneg. RI 27/<strong>03</strong>/12 PD0212611Tidak melampirkan FCSertifikat3509 08/<strong>03</strong>/2<strong>01</strong>2 <strong>01</strong>0/209/UMUM/2<strong>01</strong>2 Direktur Rumah sakit Umum Bangli 28/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02127583510 08/<strong>03</strong>/2<strong>01</strong>2 W24‐U/316/KP.10.10/II/2<strong>01</strong>2 Panitera / Sekretaris Pengadilan Tinggi Denpasar 27/<strong>03</strong>/12 PD0212610 <strong>No</strong>n sosialisasi Perpres 543511 08/<strong>03</strong>/2<strong>01</strong>2 B/587/III/2<strong>01</strong>2 Kepala Kepolisian Resort Lebak 27/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02126823512 08/<strong>03</strong>/2<strong>01</strong>2 ‐Kepala Dinas Pekerjaan Umum Pemkab Hulu SungaiSelatan28/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 PD02127873513 08/<strong>03</strong>/2<strong>01</strong>2 28/SRT/SPFPP‐KA/III/2<strong>01</strong>2Pejabat Pembuat Komitmen Satker. Pengembangandan Peningkatan Prasarana Perkeretaapian27/<strong>03</strong>/12 02‐4‐2<strong>01</strong>2 02<strong>01</strong>290047183514 08/<strong>03</strong>/2<strong>01</strong>2 5<strong>03</strong>/93/II/2<strong>01</strong>2/DTRK3515 08/<strong>03</strong>/2<strong>01</strong>2 Set.IV/KP/02.2/241/2<strong>01</strong>23516 08/<strong>03</strong>/2<strong>01</strong>2 SD/DPTR/II/2<strong>01</strong>2Kepala Dinas Tata Ruang Dan Kebersihan Pemkab.MamujuSekretaris Direktorat Jendral Bimbingan MasyarakatKatolikPlt. Kepala Pemukiman Dan Tata Ruang Pemkab. TanaToraja27/<strong>03</strong>/12 <strong>03</strong>‐4‐2<strong>01</strong>2 02<strong>01</strong>2294667227/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 02<strong>01</strong>2900470827/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02127183517 08/<strong>03</strong>/2<strong>01</strong>2 050/0799 Sekretaris Daerah Setda. Pemkab. Tegal 28/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02156843518 08/<strong>03</strong>/2<strong>01</strong>2 800/523/Peg. Direktur RSUD Gunungsitoli 28/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD0215687Hal 178

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3519 08/<strong>03</strong>/2<strong>01</strong>2 <strong>03</strong>3/1/III/Bappeda‐LK/2<strong>01</strong>2 Kepala Bappeda Pemkab. Lima Puluh kota 27/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02157043520 08/<strong>03</strong>/2<strong>01</strong>2 Pd.<strong>01</strong>.02‐SI.02/17 Kepala Balai Diklat PU Wilayah II Bandung 27/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 02<strong>01</strong>290047193521 08/<strong>03</strong>/2<strong>01</strong>2 10/800/DBM‐SDA/III/2<strong>01</strong>2Kepala Dinas Bina Marga dan Sumber Daya Air Kab.Kutai kartanegara27/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD021566<strong>03</strong>522 09/<strong>03</strong>/2<strong>01</strong>2 477/RRI‐DPR/SEK/2<strong>01</strong>2 Kepala RRI Denpasar 27/<strong>03</strong>/12 PD0212600 Sertifikat masih berlaku3523 09/<strong>03</strong>/2<strong>01</strong>2 S‐29.a/BPP.<strong>03</strong>/2<strong>01</strong>2Kepala Balai Pendidikan Dan Pelatihan KeuanganPalembang27/<strong>03</strong>/12 PD02126<strong>01</strong>Sertifikat masih berlaku dantidak ada Sosialisasi perpres543524 09/<strong>03</strong>/2<strong>01</strong>2 KP.405/1/4/DJPU‐2<strong>01</strong>2 Sekretaris Direktorat Jendral Perhubungan Udara 27/<strong>03</strong>/12 PD0212608 Sertifikat masih berlaku3525 09/<strong>03</strong>/2<strong>01</strong>2 ‐ Hari Purwanto 27/<strong>03</strong>/12 PD0212609 Sertifikat masih berlaku3526 09/<strong>03</strong>/2<strong>01</strong>2 510.2/38/ULP Kepala Unit Layanan Pengadaan Pemkab. Majalengka 29/<strong>03</strong>/12 02<strong>01</strong>29004789 Sertifikat masih berlaku3527 09/<strong>03</strong>/2<strong>01</strong>2 W10.e26.kp.<strong>03</strong>.<strong>03</strong>.04‐2473528 09/<strong>03</strong>/2<strong>01</strong>2 560/3291/2<strong>01</strong>2Kepala Lembaga Pemasyarakatan Wanita Klas II AMalangKepala Dinsos Naker dan Mobilitas Penduduk Kab.Aceh Utara29/<strong>03</strong>/12 02<strong>01</strong>29004790 Sertifikat masih berlaku22/<strong>03</strong>/12 30‐3‐2<strong>01</strong>2 PD02127633529 09/<strong>03</strong>/2<strong>01</strong>2 520.2/616/Sek/III/2<strong>01</strong>2 Kepala Distangan horti, nakbun Kab. Pesisir Selatan 02/04/12 PD0212752Sertifikat masih berlaku danTidak melampirkanketerangan mengikutisosialisasi perpres no.54tahun 2<strong>01</strong><strong>03</strong>530 09/<strong>03</strong>/2<strong>01</strong>2 AU.108/1/<strong>01</strong>/BTH‐HN/2<strong>01</strong>2 Kepala Bandar Udara Hang Nadim 02/04/12 PD0212753 Sertifikat masih berlaku3531 09/<strong>03</strong>/2<strong>01</strong>2 ‐ Dinas Pengadaan TNI Angkatan Laut 27/<strong>03</strong>/12 PD0212606 Sertifikat masih berlaku3532 09/<strong>03</strong>/2<strong>01</strong>2 ‐Kepala Balai Pembibitan Ternak Unggul Sapi PotongPadang Mengatas04/04/12 PD0212743Tidak melampirkanketerangan mengikutisosialisasi perpres no.54tahun 2<strong>01</strong>0Hal 179

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3533 09/<strong>03</strong>/2<strong>01</strong>2 ‐ M.Amin, S.Pd, MM <strong>03</strong>/04/12 PD0212694Tidak Melampirkan SuratPermohonan Konversi3534 09/<strong>03</strong>/2<strong>01</strong>2 800/143/Diklat/2<strong>01</strong>23535 09/<strong>03</strong>/2<strong>01</strong>2 Kd.02.25/5/HM.OO/<strong>03</strong>6/2<strong>01</strong>23536 09/<strong>03</strong>/2<strong>01</strong>2 900/409/I.04/2<strong>01</strong>2Kepala Badan Pendidikan Dan Pelatihan Prov.Kepulauan Bangka BelitungKepala Kantor Kab. Humbang Hasundutan KementrianAgamaKepala Bagian Administrasi Pembangunan Kota BandarLampung28/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 PD02157174‐4‐2<strong>01</strong>2 04‐4‐2<strong>01</strong>2 PD021577629/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02157073537 09/<strong>03</strong>/2<strong>01</strong>2 024/55/Adm Pemb/2<strong>01</strong>2 Sekretaris Daerah Pemkab. Lombok Barat 29/<strong>03</strong>/12 09‐4‐2<strong>01</strong>2 PD02156733538 09/<strong>03</strong>/2<strong>01</strong>2 892.3/176‐Diklat.10 Kepala Badan Kepegawaian Daerah Kab. Indramayu 29/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02157313539 09/<strong>03</strong>/2<strong>01</strong>2 893/0535/BKD Kepala Badan Kepegawaian Daerah Pemkab. Sleman 28/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02157423540 09/<strong>03</strong>/2<strong>01</strong>2 893.4‐A/862/2<strong>01</strong>2 Kepala Dinas Pengairan Aceh 29/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02127143541 09/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/71.37/Sek/PD3542 09/<strong>03</strong>/2<strong>01</strong>2 KP405/1/3 Phb 2<strong>01</strong>23543 09/<strong>03</strong>/2<strong>01</strong>2 <strong>03</strong>/40/II/Ro.Perkap/2<strong>01</strong>2Kepala Dinas Pendidikan Daerah Provinsi SulawesiTengahKepala Biro Keuangan dan Perlengkapan SekretariatJendral Kementrian PerhubunganKepala Biro Perlengkapan Dan Pengelola Aset Setda.Pemprov. Sumatera Utara28/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD021568829/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 02<strong>01</strong>2900465228/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02156693544 09/<strong>03</strong>/2<strong>01</strong>2 640/Bag.Pemb./21/III/2<strong>01</strong>2 Kepala Bagian Pembangunan Setda Gorontalo Utara 05 April 2<strong>01</strong>2 PD02126983545 09/<strong>03</strong>/2<strong>01</strong>2 020/798/III/2<strong>01</strong>2Kepala Dinas Kelautan dan Perikanan ProvinsiSumatera Utara05 April 2<strong>01</strong>2 PD02126973546 12/<strong>03</strong>/2<strong>01</strong>2 550/68/DISHUBKOMINFO/2<strong>01</strong>2 Kepala Dishubkominfo Kab. Tojo Una‐Una 02/04/12 PD0212754Tidak melampirkanketerangan mengikutisosialisasi perpres no.54tahun 2<strong>01</strong>0Hal 180

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3547 12/<strong>03</strong>/2<strong>01</strong>2 060/235/2<strong>01</strong>2 Plt. Direktur Bina Teknik Dirjen. Bina Marga 02/04/12 PD02126993548 12/<strong>03</strong>/2<strong>01</strong>2 05/ADM.PEMB/III/2<strong>01</strong>2 Plh. Sekretaris Daerah Setda. Pemkab. Baubau 02/04/12 PD02127<strong>01</strong>Tidak melampirkan suratpermohonan konversi3549 12/<strong>03</strong>/2<strong>01</strong>2 PD.<strong>01</strong>.<strong>01</strong>.CS3/I/<strong>03</strong>/2<strong>01</strong>2Kepala Bagian Kepegawaian dan Ortala SekretariatDirjen. Cipta Karya02/04/12 04‐4‐2<strong>01</strong>2 PD02157183550 12/<strong>03</strong>/2<strong>01</strong>2 ‐ Ahmad Tavip, SIP 30/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02157243551 12/<strong>03</strong>/2<strong>01</strong>2 062/S.Ket/Asdep.JPP/iii/2<strong>01</strong>2 Asisten Depuiti Jaringan Penyedia PUSPITEK 29/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02127173552 12/<strong>03</strong>/2<strong>01</strong>2 1278/‐1.828.2 Kepala Pendaratan DKI Jakarta 29/<strong>03</strong>/12 05‐4‐2<strong>01</strong>2 PD02127273553 12/<strong>03</strong>/2<strong>01</strong>2 890/71/Diklat/2<strong>01</strong>2Kepala Badan Kepegawaian Pendidikan Dan PelatihanKab. Aceh Barat Daya02/04/12 09‐April‐2<strong>01</strong>2 PD02156763554 12/<strong>03</strong>/2<strong>01</strong>2 KP.104/04/30/Ad.Kdi‐2<strong>01</strong>2 Kepala Kantor Admiinistrator Pelabuhan Kendari 05 April 2<strong>01</strong>2 PD02126893555 12/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/0460/431.006.4/2<strong>01</strong>2 Asisten Administrasi Umum Setda. Pemkab. Situbondo 05 April 2<strong>01</strong>2 PD<strong>01</strong>269<strong>03</strong>556 12/<strong>03</strong>/2<strong>01</strong>2 600/81/Bang‐II/2/2<strong>01</strong>2Asisten Perekonomian & Pembangunan Setda.Pemkab. Berau09 April 2<strong>01</strong>2 PD0212705Sudah pernah konversi, <strong>No</strong>nsosialisai, Tidakmelampirkan fotocopysertifikat3557 12/<strong>03</strong>/2<strong>01</strong>2 S‐247/WPJ.04/BG.<strong>01</strong>/2<strong>01</strong>2Kepala Bagian Umum Dirjen. Pajak kantor Wilayah DJPJakarta Selatan05 April 2<strong>01</strong>2 PD02126963558 12/<strong>03</strong>/2<strong>01</strong>2 91<strong>03</strong>1.006 Kepala Badan Pusat Statistik Kab. Teluk Wondama 05 April 2<strong>01</strong>2 PD02126953559 13/<strong>03</strong>/2<strong>01</strong>2 5681‐089.3Kepala Suku Dinas Perhubungan Kota AdministrasiJakarta Selatan30/<strong>03</strong>/12 04‐4‐2<strong>01</strong>2 02<strong>01</strong>290047133560 13/<strong>03</strong>/2<strong>01</strong>2 600/007‐DPU/III/2<strong>01</strong>2 Sekretaris DPU Pemkab Pandeglang 04/04/12 PD0212748Hal 181

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3561 13/<strong>03</strong>/2<strong>01</strong>2 PD<strong>01</strong><strong>01</strong>‐S1.7/109 Kepala Balai Diklat PU Wilayah VII Palembang 04/04/12 PD021274<strong>03</strong>562 13/<strong>03</strong>/2<strong>01</strong>2 600/132/SP/2<strong>01</strong>2Kepala Dinas Sumber Daya Air Dan PemukimanProvinsi Banten<strong>03</strong>/04/12 09‐4‐2<strong>01</strong>2 PD02156723563 13/<strong>03</strong>/2<strong>01</strong>2 2852.24/05/04/2<strong>01</strong>2 Sekretaris Daerah Setda. Pemkab Lampung Barat <strong>03</strong>/04/12 09‐April‐2<strong>01</strong>2 PD02156613564 13/<strong>03</strong>/2<strong>01</strong>2 800/510/Peg Direktur RSUD Gunungsitoli 30/<strong>03</strong>/12 09‐April‐2<strong>01</strong>2 PD02156753565 13/<strong>03</strong>/2<strong>01</strong>2 118A/078.62 Kepala Puskesmas Pancoran 09 April 2<strong>01</strong>2 PD0212704 <strong>No</strong>n sosialisasi3566 13/<strong>03</strong>/2<strong>01</strong>2 UM.0<strong>03</strong>/6/I/DNG.Bna‐12 Kepala Distrik Navigasi Kelas Benoa 09 April 2<strong>01</strong>2 PD0212733 Masih berlaku3567 13/<strong>03</strong>/2<strong>01</strong>2 020/00223/ROI/2<strong>01</strong>2 Ub Kepala Biro Pemerintahan Setda Pemprov. DIY 05 April 2<strong>01</strong>2 PD02127473568 13/<strong>03</strong>/2<strong>01</strong>2 W7.AHU.2.PL.02.<strong>03</strong>‐022 Ketua Balai Harta Peninggalan Jakarta 05 April 2<strong>01</strong>2 PD<strong>01</strong>27463569 14/<strong>03</strong>/2<strong>01</strong>2 520/206/2<strong>01</strong>2 kepala Dinas Pertanian Tanaman Pangan Aceh 09 April 2<strong>01</strong>2 PD0212708 Sudah pernah dikonversi3570 14/<strong>03</strong>/2<strong>01</strong>2 9<strong>03</strong>/229/Dinkes/2<strong>01</strong>2 Kepala Dinas Kesehatan Kab. Padang Pariaman 09 April 2<strong>01</strong>2 PD02127063571 14/<strong>03</strong>/2<strong>01</strong>2 420/ /V/2<strong>01</strong>2 Kepala Dinas Pendidikan Kab. Muara Enim 09 April 2<strong>01</strong>2 PD02157353572 14/<strong>03</strong>/2<strong>01</strong>2 180.11/217/111/2<strong>01</strong>2 Sekretaris Daerah Setda Pemkab. Mamuju Utara 09 April 2<strong>01</strong>2 PD0212731 Sertifikat masih berlaku3573 15/<strong>03</strong>/2<strong>01</strong>2 ‐ Denny Efendi 09 April 2<strong>01</strong>2 PD02157373574 15/<strong>03</strong>/2<strong>01</strong>2 S.646/SET‐3/2<strong>01</strong>2Sekretaris Ditjend Bina Pengelolaan Daerah AliranSungai dan Perhutanan Sosial, Kem. Kehutanan09 April 2<strong>01</strong>2 PD02157343575 15/<strong>03</strong>/2<strong>01</strong>2 95/071.511 Camat Kramat Jati 09 April 2<strong>01</strong>2 PD0212709Tidak ada SosialisasiPerpres 54 tahun 2<strong>01</strong>0Hal 182

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3576 15/<strong>03</strong>/2<strong>01</strong>2 ‐ Yakobus Sakunab 09 April 2<strong>01</strong>2 PD02127323577 16/<strong>03</strong>/12 800/766/Kepeg/2<strong>01</strong>2 Dinas Peternakan dan Kesehatan Hewan Prov. NTT 09 April 2<strong>01</strong>2 PD0212707Tidak ada SosialisasiPerpres 54 tahun 2<strong>01</strong>0Tidak melampirkan suratpermohonan konversi3578 16/<strong>03</strong>/12 ‐ Zulfikar Diansyah 09 April 2<strong>01</strong>2 PD02157363579 26/<strong>03</strong>/2<strong>01</strong>2 ‐ Kepala Dinas Pertanian Pemkab Jeneponto3580 28/<strong>03</strong>/2<strong>01</strong>2 Balai Diklat Wilayah V Makassar3581 13/<strong>03</strong>/2<strong>01</strong>2 69/‐082.74Kepala Suku Dinas Pertamanan Kota AdministrasiJakarta Utara9‐Apr‐12Proses3582 06/02/2<strong>01</strong>2 050/072/2<strong>01</strong>2 Setdakab Aceh Selatan 30/<strong>03</strong>/12 Proses3583 06/<strong>03</strong>/2<strong>01</strong>2 1416/UN16.8/TU/2<strong>01</strong>1 Panitia Rekap Data Universitas Andalas 28/<strong>03</strong>/12 Proses3584 26/07/2<strong>01</strong>1 524.912/162/DISNAK/VII/2<strong>01</strong>1 Kepala Dinas Peternakan Kab. Timor Tengah Utara <strong>03</strong>/11/11 Proses3585 26/10/2<strong>01</strong>1 800/392/S1/BAPP/10/2<strong>01</strong>1 Sekretaris Bappeda Pemkot Samarinda 13/11/11 Proses3586 04/11/2<strong>01</strong>1 - Kabag Tata Pemerintahan setdakab bintuhan 28/11/11 Proses3587 20/12/2<strong>01</strong>1 ?3588 20/12/2<strong>01</strong>1 UM0<strong>03</strong>/32/10/DV-11Kepala BBWS Bengawan Solo Ditjend SDAKementerian PUDirektur Kenavigasian Ditjend Perhubungan LautKementerian Perhubungan02/<strong>01</strong>/12 Proses02/<strong>01</strong>/12 Proses3589 20/12/2<strong>01</strong>1 UM.<strong>03</strong>.02/BBWS.CC/II/24 Kepala BBWS Ciliwung Cisadane 23/12/11 Proses3590 21/12/2<strong>01</strong>1 326/BPSDMKP.<strong>01</strong>/TU.210/XII/2<strong>01</strong>1Sekretaris BPSDMKP Kementerian Kelautan danPerikanan02/<strong>01</strong>/12 Proses3591 <strong>03</strong>/<strong>01</strong>/2<strong>01</strong>2 826.4.2549/Bang-Dik/XII/2<strong>01</strong>1 Direktur RSUD A. Wahab Sjahranie 17/<strong>01</strong>/12 Proses3592 09/<strong>01</strong>/2<strong>01</strong>2 RSUD Dr. Kanujoso Djatiwibowo Balikpapan 20/<strong>01</strong>/12 Proses3593 11/<strong>01</strong>/2<strong>01</strong>2 800/11/1.21.02/2<strong>01</strong>2Kepala Badan Kepegawaian Daerah PemerintahKabupaten Bangka Barat<strong>01</strong>/02/12 ProsesHal 183

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3594 17/<strong>01</strong>/2<strong>01</strong>2 PD.<strong>01</strong>.02-Sl.02/<strong>01</strong>Kepala Balai Diklat Wil II Bandung Pusdiklat SetjenKementerian PU10/02/12 Proses3595 18/<strong>01</strong>/2<strong>01</strong>2 892.3/80/Bappeda dan PM Kepala Bappeda dan Penanaman Modal Kab. Bangli <strong>03</strong>/02/12 Proses3596 24/<strong>01</strong>/2<strong>01</strong>2 440.441.7/511/I/2<strong>01</strong>2 Kepala Dinas Kesehatan Prov. Sumatera Utara 14/02/12 Proses3597 25/<strong>01</strong>/2<strong>01</strong>2 KM.<strong>03</strong>.02/IX.5/092/2<strong>01</strong>23598 07/02/2<strong>01</strong>2 <strong>027</strong>/<strong>01</strong>43/KPKasubag Tata Usaha BTKLPP Kelas I Batam DitjenPengendalian Penyakit dan Penyehatan LingkunganKemenkes RIKepala Dinas Pertanian, Kehutanan dan KelautanPemkot Palu09/02/12 Proses24/02/12 Proses3599 30/06/2<strong>01</strong>1 ? Sekretariat Lembaga Kajian Indonesia Pekan Baru <strong>01</strong>/11/11 Proses3600 23/02/2<strong>01</strong>2 - Khalid Mustafa, S.T 16/<strong>03</strong>/12 Proses36<strong>01</strong> 23/02/2<strong>01</strong>2 024.2/<strong>027</strong>11Sekretaris Badan Perencanaan Pembangunan DaerahSemarang16/<strong>03</strong>/12 Proses3602 14/07/2<strong>01</strong>1 - LPKN 02/11/11 Proses36<strong>03</strong> 06/<strong>03</strong>/2<strong>01</strong>2 KP.405/1/2 Phb2<strong>01</strong>23604 06/<strong>03</strong>/2<strong>01</strong>2 050/185/Dalbang.2<strong>01</strong>2Kepala Biro Umum Sekretariat Jendral KementrianPerhubunganKepala Bagian Pengendalian Pembangunan SetdaPemkot Banjarmasin26/<strong>03</strong>/12 Proses26/<strong>03</strong>/12 Proses3605 06/<strong>03</strong>/2<strong>01</strong>2 <strong>01</strong>3.6/‐084.6 Kepala Puskesmas Kecamatan Ciracas 26/<strong>03</strong>/12 Proses3606 09/<strong>03</strong>/2<strong>01</strong>2 1534/B.04/<strong>03</strong>/2<strong>01</strong>2Kepala Biro Perencanaan, Organisasi dan Tata LaksanaBappenas26/<strong>03</strong>/12 Proses3607 <strong>01</strong>/<strong>03</strong>/2<strong>01</strong>2 0<strong>03</strong>/LKI‐Konversi/VII/2<strong>01</strong>2 Ketua Lembaga Kajian Indonesia 27/<strong>03</strong>/12 Proses3608 06/<strong>03</strong>/2<strong>01</strong>2 222/FTP‐UGM/LK/2<strong>01</strong>2 Kepala Kantor Administrasi Universitas Gajah Mada 02/04/12 Proses3609 06/<strong>03</strong>/2<strong>01</strong>2 B/402/II/2<strong>01</strong>2/SSDM Kabagrenmin Mabes Kepolisian Negara RI Staf SDM 28/<strong>03</strong>/12 ProsesHal 184

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3610 06/<strong>03</strong>/2<strong>01</strong>2 070/BPIPBPJK/13/2<strong>01</strong>1Kepala Balai PIPBPJK Dinas PU ‐ ESDM PemerintahProv. DIY28/<strong>03</strong>/12 Proses3611 06/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/454/PEMB/II/2<strong>01</strong>2 Sekretaris Daerah Pemkab Samosir 28/<strong>03</strong>/12 Proses3612 06/<strong>03</strong>/2<strong>01</strong>2 374/I.5.3/TVRI/2<strong>01</strong>2 GM. Sumber Daya Manusia TVRI 29/<strong>03</strong>/12 Proses3613 06/<strong>03</strong>/2<strong>01</strong>2 KP.<strong>01</strong>.<strong>01</strong>‐Ca.121/Pk‐PAM/08 Kepala SNVT, Pengembangan Kinerja PAM Jawa Timur 29/<strong>03</strong>/12 Proses3614 07/<strong>03</strong>/2<strong>01</strong>2 912/PROPEMB/2<strong>01</strong>2/34Asisten Administrasi Pembangunan Setda. PemkabPelalawan29/<strong>03</strong>/12 Proses3615 07/<strong>03</strong>/2<strong>01</strong>2 500/<strong>03</strong>3/III/Ekbang/2<strong>01</strong>2 Wakil Bupati Luwu Timur 27/<strong>03</strong>/12 Proses3616 08/<strong>03</strong>/2<strong>01</strong>2 800/166/Dalbang‐2<strong>01</strong>2 Sekretaris Daerah Kab. Tanah Datar 29/<strong>03</strong>/12 Proses3617 08/<strong>03</strong>/2<strong>01</strong>2 06/UN5.2.3.2/PPM/2<strong>01</strong>23618 09/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/233/III.2<strong>01</strong>2Ketua Universitas Sumatera Utara LembagaPengabdian MasyarakatKepala Badan Perpustakaan dan Arsip Daerahpemprov. Maluku<strong>03</strong>/04/12 Proses28/<strong>03</strong>/12 Proses3619 09/<strong>03</strong>/2<strong>01</strong>2 893/<strong>03</strong>78/Diklat Kepala Badan Pendidikan dan Pelatihan Pemprov. DIY 28/<strong>03</strong>/12 Proses3620 09/<strong>03</strong>/2<strong>01</strong>2 W.29.UM.<strong>01</strong>.<strong>01</strong>‐0883621 09/<strong>03</strong>/2<strong>01</strong>2 522/294/2/20‐LU.2<strong>01</strong>2Kepala Kantor Wilayah Banten Kementrian Hukum danHAM R.IKepala Dinas Kehutanan dan Perkebunan Kab.Lampung Utara30/<strong>03</strong>/12 Proses28/<strong>03</strong>/12 Proses3622 09/<strong>03</strong>/2<strong>01</strong>2 UM.<strong>03</strong>.II‐BU/140 Kepala Balai Besar Pelaksanaan Jalan Nasional III 29/<strong>03</strong>/12 Proses3623 09/<strong>03</strong>/2<strong>01</strong>2 68/‐1/712Plt. Kepala Dinas Koperasi Usaha Mikro, Kecil DanMenengah Dan Perdagangan Prov. DKI Jakarta29/<strong>03</strong>/12 ProsesHal 185

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3624 09/<strong>03</strong>/2<strong>01</strong>2 S‐212/WBC.15/PSO/2<strong>01</strong>2Kepala Pangkalan Sarana Operasi Tipe B PantoloanKanwil Sulawesi Ditjen Bea Cukai Kemen Keu RI29/<strong>03</strong>/12 Proses3625 09/<strong>03</strong>/2<strong>01</strong>2 3126/H2.F1.D1.3/LOG.<strong>01</strong>/2<strong>01</strong>2 Dekan Fakultas Kedokteran Universitas Indonesia 29/<strong>03</strong>/12 Proses3626 09/<strong>03</strong>/2<strong>01</strong>2 58/UN7.ULP/KP/2<strong>01</strong>2 Ketua ULP Universitas Diponegoro 30/<strong>03</strong>/12 Proses3627 09/<strong>03</strong>/2<strong>01</strong>2 616/Bd/BBIA/III/2<strong>01</strong>2 Plh. Kepala Balai Besar Industri Agro 29/<strong>03</strong>/12 Proses3628 09/<strong>03</strong>/2<strong>01</strong>2 524/DISNAK‐UM/2<strong>01</strong>2/067 Sekretaris Dinas Peternakan Pemkab. Pelalawan 29/<strong>03</strong>/12 Proses3629 09/<strong>03</strong>/2<strong>01</strong>2 551/121/Dishubkominfo/2<strong>01</strong>2 Kepala Dishubkominfo Kab. Bangli 29/<strong>03</strong>/12 Proses3630 09/<strong>03</strong>/2<strong>01</strong>2 028/369/Set Sekretaris Daerah Pemkab. Maros 02/04/12 Proses3631 09/<strong>03</strong>/2<strong>01</strong>2 B.854/P2HP.0/KP.210/III/2<strong>01</strong>2Sekretaris Direktorat Jendral Pengolahan danPemasaran Hasil Perikanan<strong>03</strong>/04/12 Proses3632 12/<strong>03</strong>/2<strong>01</strong>2 71061.0<strong>01</strong> Kepala Badan Pusat Statistik Kab. Minahasa Utara 29/<strong>03</strong>/12 Proses3633 12/<strong>03</strong>/2<strong>01</strong>2 Kd.17.08./KU.00.2/315/2<strong>01</strong>2Kepala Kantor Kementrian Agama Kab. Hulu SungaiUtara29/<strong>03</strong>/12 Proses3634 12/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/512/Sekr Kepala Dinas Kehutanan Pemprov. Jawa Barat 29/<strong>03</strong>/12 Proses3635 12/<strong>03</strong>/2<strong>01</strong>2 060/235/2<strong>01</strong>2 Sekretaris Daerah Setda. Pemkab. Konawe Selatan 02/04/12 Proses3636 12/<strong>03</strong>/2<strong>01</strong>2 118/UN19.2/PL/2<strong>01</strong>2 Ketua Lembaga Penelitian Universitas Riau 02/04/12 Proses3637 12/<strong>03</strong>/2<strong>01</strong>2 136/J34/KP/2<strong>01</strong>2 Kepala PMP NTB 02/04/12 Proses3638 13/<strong>03</strong>/2<strong>01</strong>2 600/54/Pemb/2<strong>01</strong>2 Sekretaris Daerah Pemkab Hulu Sungai Utara 30/<strong>03</strong>/12 ProsesHal 186

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3639 13/<strong>03</strong>/2<strong>01</strong>2 799/‐074Kepala Biro Perekonomian Sekretariat DaerahPemprov DKI Jakarta30/<strong>03</strong>/12 Proses3640 13/<strong>03</strong>/2<strong>01</strong>2 1207/C.C1/IK/2<strong>01</strong>2 Sekretaris Ditjend Pendidikan Dasar Kemdikbud 02/04/12 Proses3641 13/<strong>03</strong>/2<strong>01</strong>2 800/1868/431.304.4/2<strong>01</strong>2 Sekretaris Daerah Setda Pemkab Situbondo 02/04/12 Proses3642 13/<strong>03</strong>/2<strong>01</strong>2 057b/H1.5.21/LK/2<strong>01</strong>2Badan Pengembangan Dan Pembinaan Bahasa Prov.NTB<strong>03</strong>/04/12 Proses3643 13/<strong>03</strong>/2<strong>01</strong>2 UM.0502/BB/III/33 Kepala Balai Bendungan Ditjen SDA kementerian PU <strong>03</strong>/04/12 Proses3644 13/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/92/Set Camat Margahayu Pemkab Bandung <strong>03</strong>/04/12 Proses3645 13/<strong>03</strong>/2<strong>01</strong>2 654/DTKTRANS‐02/2<strong>01</strong>2Kepala Dinas Tenaga Kerja dan Transmigrasi Pemprov.Bengkulu<strong>03</strong>/04/12 Proses3646 13/<strong>03</strong>/2<strong>01</strong>2 W4.UI/1632/PL.<strong>01</strong>.10/II/2<strong>01</strong>2 Panitera/Sekretaris Pengadilan Negeri Pekanbaru <strong>03</strong>/04/12 Proses3647 13/<strong>03</strong>/2<strong>01</strong>2 B/1608/08/23/<strong>01</strong>/SETKepala Bagian Umum Badan Petahanan KemhanSekretariat<strong>03</strong>/04/12 Proses3648 13/<strong>03</strong>/2<strong>01</strong>2 1258/UN23.9/KS.00.<strong>01</strong>/2<strong>01</strong>2 Ketua LPPM Universitas Jendral Soedirman <strong>03</strong>/04/12 Proses3649 13/<strong>03</strong>/2<strong>01</strong>2 SEK.4.PL.02.<strong>03</strong>‐184Kepala Biro Perlengkapan Setjend Kementerian Hukumdan HAM04/04/12 Proses3650 13/<strong>03</strong>/2<strong>01</strong>2 893.3/427/418.64/2<strong>01</strong>2 Sekretaris Daerah Setda Pemkab. Kediri 05/04/12 Proses3651 13/<strong>03</strong>/2<strong>01</strong>2 175/330/<strong>027</strong>/04‐UMUM/2<strong>01</strong>2 Sekretaris DPRD Kab. Kutai Kartanegara 4‐Apr‐12 Proses3652 13/<strong>03</strong>/2<strong>01</strong>2 19/H21.18.1/LL/2<strong>01</strong>2Ketua Program Pasca Sarjana Magister ManagemenUniversitas Jambi9‐Apr‐12Proses3653 13/<strong>03</strong>/2<strong>01</strong>2 ‐Sekretaris Dinas Pekerjaan Umum Pemda Prov.Sulawesi Tengah9‐Apr‐12ProsesHal 187

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3654 14/<strong>03</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>03</strong>/AZ/433655 14/<strong>03</strong>/2<strong>01</strong>2 S‐493/WBC.09/KPP.04/2<strong>01</strong>2Kepala Balai Besar Wilayah Sungai Cidanau ‐ Ciujung ‐CidurianKepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe A3 Cilacap<strong>03</strong>/04/12 Proses<strong>03</strong>/04/12 Proses3656 14/<strong>03</strong>/2<strong>01</strong>2 ‐ Kepala Dinas Pekerjaan Umum Kab Tojo Una‐Una 9‐Apr‐12 Proses3657 14/<strong>03</strong>/2<strong>01</strong>2 522.21/DISTANHUT‐ARU/173/2<strong>01</strong>2Plt. Kepala Dinas Pertanian Dan Kehutanan PemkabKepulauan Aru4‐Apr‐12Proses3658 14/<strong>03</strong>/2<strong>01</strong>2 810/146/123Asisten Ekonomi, Pembangunan dan Kesra Sekda KotaMagelang4‐Apr‐12Proses3659 14/<strong>03</strong>/2<strong>01</strong>2 S.20/PSIK‐PP/<strong>03</strong>.2<strong>01</strong>2 Pusat Studi Investasi Dan Keuangan 4‐Apr‐12 Proses3660 14/<strong>03</strong>/2<strong>01</strong>2 KU.<strong>03</strong>.<strong>03</strong>.4144.2<strong>01</strong>2 Direktur Politeknik Kesehatan Gorontalo 4‐Apr‐12 Proses3661 14/<strong>03</strong>/2<strong>01</strong>2 UM.0<strong>01</strong>/3/13/PLP.TPK‐12Kasubag Tata Usaha Pangkalan Penjagaan Laut DanPantai Kelas I Tanjung Priok4‐Apr‐12Proses3662 14/<strong>03</strong>/2<strong>01</strong>2 893/65Kepala Badan Pemberdayaan Masyarakat DanPemrintahan Desa Pemkab. Kep. Riau4‐Apr‐12Proses3663 15/<strong>03</strong>/2<strong>01</strong>2 ‐ Sekretaris DPRD Kota Bandar Lampung 5‐Apr‐12 Proses3664 15/<strong>03</strong>/2<strong>01</strong>2 090/DISHUBKOMINFO/2<strong>01</strong>2/17Kepala Dinas Perhubungan, Komunikasi danInformatika Pemkab Natuna5‐Apr‐12Proses3665 15/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/093/DisbudparKepala Dinas Kebudayaan dan Periwisata PemkabBangli5‐Apr‐12Proses3666 15/<strong>03</strong>/2<strong>01</strong>2 321/<strong>01</strong>/Dikes/III/2<strong>01</strong>2 Kepala Dinas Kesehatan Pemkab Lombok Utara 5‐Apr‐12 Proses3667 15/<strong>03</strong>/2<strong>01</strong>2 800.05/79/TK/2<strong>01</strong>2 Kepala Dinas Tata Kota Pemkot Jayapura 5‐Apr‐12 Proses3668 15/<strong>03</strong>/2<strong>01</strong>2 600/422/PU 2<strong>01</strong>2 Dinas Pekerjaan Umum Pemkab Kapuas 5‐Apr‐12 ProsesHal 188

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3669 15/<strong>03</strong>/2<strong>01</strong>2 800/112‐Dis.PKKepala Dinas Perikanan dan Kelautan PemkabTanggerang5‐Apr‐12Proses3670 15/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/213/424.064/2<strong>01</strong>2Kepala Dinas Kelautan dan Perikanan PemkabPasuruan5‐Apr‐12Proses3671 15/<strong>03</strong>/2<strong>01</strong>2 800/5118/Umum/2<strong>01</strong>2 Setda Pemkot Tanjungbalai <strong>03</strong>/04/12 Proses3672 15/<strong>03</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.10/PJNW‐I/<strong>01</strong>/III/237Kepala Satker Pelaksanaan Jalan Nasional Wilayah IProv. Sumatera Barat, Ditjend Bina MargaKementerian PU<strong>03</strong>/04/12 Proses3673 15/<strong>03</strong>/2<strong>01</strong>2 800/26/UPTD‐ULP/I/2<strong>01</strong>2 Kepala UPTD Layanan PBJP Pemkot Banda Aceh <strong>03</strong>/04/12 Proses3674 15/<strong>03</strong>/2<strong>01</strong>2 050/540/05/2<strong>01</strong>2 Sekretaris Daerah Pemkab Magelang <strong>03</strong>/04/12 Proses3675 15/<strong>03</strong>/2<strong>01</strong>2 <strong>01</strong>1/Srt/BIV/III/2<strong>01</strong>2KPA Satker Biro Hukum dan Kerjasama Luar NegeriSetjend Kementerian Perhubungan<strong>03</strong>/04/12 Proses3676 15/<strong>03</strong>/2<strong>01</strong>2 16/ADBANG/III/MU/2<strong>01</strong>2 Kabiro Administrasi Pembangunan Setda Maluku Utara <strong>03</strong>/04/12 Proses3677 15/<strong>03</strong>/2<strong>01</strong>2 893/425/419.62/2<strong>01</strong>2 Plt. Kepala Badan Kepegawaian Daerah Kota Kediri 09/04/2<strong>01</strong>2 Proses3678 15/<strong>03</strong>/2<strong>01</strong>2 800/316/II.06/2<strong>01</strong>2Kepala Badan Penanaman Modal dan PPTD Prov.Lampung9‐Apr‐12Proses3679 15/<strong>03</strong>/2<strong>01</strong>2 B.263/LATTAS‐SES/III/2<strong>01</strong>2 Sekretaris Ditjend Binalattas Kemenakertrans 5‐Apr‐12 Proses3680 15/<strong>03</strong>/2<strong>01</strong>2 600/315/Bangda/2<strong>01</strong>2 Sekretaris Daerah Pemkab Tanah Laut 10‐Apr‐12 Proses3681 15/<strong>03</strong>/2<strong>01</strong>2 045.2/213/Dalbang.2<strong>01</strong>2Kepala Bagian Penegndalian Pembangunan, SetdaPemkot Banjarmasin9‐Apr‐12Proses3682 15/<strong>03</strong>/2<strong>01</strong>2 158/UN37.3.1/TU/2<strong>01</strong>2 Sekretaris LP2M Univ. Negeri Semarang 10‐Apr‐12 ProsesHal 189

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3683 15/<strong>03</strong>/2<strong>01</strong>2 050/59/BP Sekretaris Daerah Pemkab. Barito Timur 9‐Apr‐12 Proses3684 16/<strong>03</strong>/12 ‐ Rika Hariaty 9‐Apr‐12 Proses3685 16/<strong>03</strong>/12 094/08b/2<strong>01</strong>2 Dinas Pekerjaan Umum Pemkab Bombana 9‐Apr‐12 Proses3686 16/<strong>03</strong>/12 900/495/P.1/Disdi/2<strong>01</strong>2 Dinas Pendidikan Pemprov. Sumatera Selatan 9‐Apr‐12 Proses3687 16/<strong>03</strong>/12 700/302/435.108/2<strong>01</strong>2 Kepala Dinas PU Bina Marga Pemkab Sumenep 9‐Apr‐12 Proses3688 16/<strong>03</strong>/12 3698/H3.5/LL/2<strong>01</strong>2 Direktur Sumberdaya Univ. Airlangga 9‐Apr‐12 Proses3689 16/<strong>03</strong>/12 W.19‐A/558/PL.<strong>01</strong>/III/2<strong>01</strong>2 Pengadilan Tinggi Agama Palu 9‐Apr‐12 Proses3690 16/<strong>03</strong>/12 <strong>027</strong>/25<strong>01</strong>Balai Pengobatan Penyakit Paru‐patu, Dinas KesehatanProv. DIY9‐Apr‐12Proses3691 16/<strong>03</strong>/12 W15‐DL.<strong>03</strong>.04‐15Kementerian Hukum dan HAM RI Kanwil SulawesiSelatan9‐Apr‐12Proses3692 16/<strong>03</strong>/12 S.467/BPDASCKY‐1/2<strong>01</strong>2Balai Pengelolaan DAS Cimanuk ‐ Citanduy DitjendBina Pengelolaan DAS dan Perhutanan SosialKementerian Kehutanan9‐Apr‐12Proses3693 19/<strong>03</strong>/2<strong>01</strong>2 ‐ Kepala Badan POM ‐ Palu 9‐Apr‐12 Proses3694 19/<strong>03</strong>/2<strong>01</strong>2 KU.008/58/KI/DJKA/12/11Sekretaris Ditjen Perkeretaapian KementerianPerhubungan9‐Apr‐12Proses3695 19/<strong>03</strong>/2<strong>01</strong>2 900/520/I.04/2<strong>01</strong>2Kepala Bagian Administrasi Pembangunan PemkotBandar Lampung9‐Apr‐12Proses3696 19/<strong>03</strong>/2<strong>01</strong>2 B/1915/III/2<strong>01</strong>2/Rumkit Kepala Polda Jawa Timur 9‐Apr‐12 Proses3697 30/12/2<strong>01</strong>1 188.41/1630/05/2<strong>01</strong>1 Sekretaris Daerah Pemkot Metro ProsesHal 190

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3698 04/<strong>01</strong>/2<strong>01</strong>2 1243/SJ.3/KOMINFO/12/2<strong>01</strong>1 Kementrian Komunikasi dan Informatika RI Proses3699 06/<strong>01</strong>/2<strong>01</strong>2 Dishut Kalimantan Selatan Proses3700 09/<strong>01</strong>/2<strong>01</strong>2 600/<strong>03</strong>9/B-UM-BAPP/2<strong>01</strong>237<strong>01</strong> 10/<strong>01</strong>/2<strong>01</strong>2 522/1545-Umpeg/DishutSekretaris Badan Perencanaan Pembangunan DaerahPemprov. Kalimantan TimurKepala Dinas Kehutanan Pemerintah ProvinsiKalimantan SelatanProsesProses3702 17/<strong>01</strong>/2<strong>01</strong>2 B/27/I/2<strong>01</strong>2 Sekretaris Kodiklat Tentara Nasional Indonesia AD Proses37<strong>03</strong> 25/<strong>01</strong>/2<strong>01</strong>2 Pemerintah Kabupaten Sumbawa Barat Proses3704 30/<strong>01</strong>/2<strong>01</strong>2 S-13/WPJ.32/KP.<strong>03</strong><strong>01</strong>/2<strong>01</strong>23705 <strong>01</strong>/02/2<strong>01</strong>2 <strong>027</strong>/65/1.20.16/2<strong>01</strong>2Kepala KPP Pratama Kebumen Kanwil Jawa Tengah IIDitjend Pajak Kementerian KeuanganKepala Dinas Pendapatan , Pengelolaan Keuangan danAsetProsesProses3706 <strong>01</strong>/02/2<strong>01</strong>2 Diskan.523/414/XII/2<strong>01</strong>0 Kepala Dinas Kelautan dan Perikanan Pemkot Kupang Proses3707 <strong>01</strong>/02/2<strong>01</strong>2 W3.PL.02.<strong>03</strong>-<strong>01</strong>3708 02/02/2<strong>01</strong>2 UM.002/61/KI/DJKA/I/12Kepala Kantor Wilayah Sumatera Selatan KementerianHukum dan HAM RISekretaris Ditjen Perkeretaapian KementerianPerhubunganProsesProses3709 08/02/2<strong>01</strong>2 185/DPU/IX/2<strong>01</strong>1 Kadinas Pu Kab. Kepulauan Talaud Proses3710 08/02/2<strong>01</strong>2 21/RSUD/II/2<strong>01</strong>2 Direktur RSUD Talaud Proses3711 21/02/2<strong>01</strong>2 SM.3<strong>01</strong>/0/1<strong>01</strong>/Ad.PP-12Kepala Kantor Administrator Pelabuhan Pulang Pisau,Ditjend Perhubungan Laut, Kementerian PerhubunganProses3712 27/02/2<strong>01</strong>2 SM.3<strong>01</strong>/1/5/DJPD/2<strong>01</strong>2 Sekretaris Ditjen. Perhubungan Darat Proses3713 29/02/2<strong>01</strong>2 196/1.195.211/2<strong>01</strong>23714 29/02/2<strong>01</strong>2 594.3/143./IKepala suku Dinas Pertamanan Kota Adm. JakartaBaratSekretaris Dinas Pertanian Tanaman Pangan DanHortikultura Kab. GroboganProsesProses3715 06/<strong>03</strong>/2<strong>01</strong>2 800/40/SDV/PA/2<strong>01</strong>2 Sekretaris Daerah Pemkot Pagar Alam ProsesHal 191

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3716 06/<strong>03</strong>/2<strong>01</strong>2 2<strong>03</strong>.a/Disnakes‐II/2<strong>01</strong>2Kepala Dinas Peternakan Dan Kesehatan HewanPemkab BulukumbaProses3717 13/<strong>03</strong>/2<strong>01</strong>2 061/84/DISBIMAIR Kepala Dinas Bina Marga dan Pengairan Kab. Banggai Proses3718 13/<strong>03</strong>/2<strong>01</strong>2 800/023/DPK/2<strong>01</strong>2Plt. Kepala Dinas Perikanan Dan Kelautan Kab. KubuRayaProses3719 13/<strong>03</strong>/2<strong>01</strong>2 900/2626 Kepala Dinas Dikpora Provinsi DIY Proses3720 14/<strong>03</strong>/2<strong>01</strong>2 W17‐UM.<strong>01</strong>.<strong>01</strong>‐3533721 14/<strong>03</strong>/2<strong>01</strong>2 0734/UN6.D2/TU/2<strong>01</strong>2Kepala Kantor Wilayah NTT Kupang KementrianHukum dan HAM RIPembantu Dekan II Fakultas Matematika Dan IlmuPengetahuan Alam Universitas PadjadjaranProsesProses3722 15/<strong>03</strong>/2<strong>01</strong>2 B/07/I/2<strong>01</strong>2/Rumkit Kepala RS Bhayangkara ‐ Palembang Proses3723 15/<strong>03</strong>/2<strong>01</strong>2 B‐1089/N.6.10/Cp.2/<strong>03</strong>/2<strong>01</strong>2 Kepala Kejaksaan Negeri Palembang Proses3724 15/<strong>03</strong>/2<strong>01</strong>2 16510.996 Kepala Badan Pusat Statistik Prov. Sumatera Selatan Proses3725 15/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/31/05/UK/2<strong>01</strong>2 Sekretaris Daerah Pemkab Lampung Timur Proses3726 15/<strong>03</strong>/2<strong>01</strong>2 W7.EP.UM.<strong>01</strong>.<strong>01</strong>‐124Kepala Rumah Penyimpanan Benda Sitaan Negara KlasI Jakarta Timur, Kemhukham Kanwil DKI JakartaProses3727 16/<strong>03</strong>/12 B/581/III/2<strong>01</strong>2 Mabes AD Proses3728 16/<strong>03</strong>/12 ‐ Irma Yuwinda Proses3729 16/<strong>03</strong>/12 800/081‐Kec.Regol Kecamatan Regol, Pemkot Bandung Proses3730 16/<strong>03</strong>/12 0227/212/Dispora/2<strong>01</strong>2Dinas Pemuda dan Olahraga Pemprov. SumateraSelatanProsesHal 192

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3731 16/<strong>03</strong>/12 0227/0679/V/2<strong>01</strong>2 Setda Pemprov. Sumatera Selatan Proses3732 16/<strong>03</strong>/12 PD.02<strong>03</strong>‐Cb/573Dit. Penataan Bangunan dan Lingkungan Ditjend CiptaKarya Kem. PUProses3733 19/<strong>03</strong>/2<strong>01</strong>2 166/UM‐POLMAN BABEL/2<strong>01</strong>2 Direktur Politeknik Manufaktur Negeri Bangka Belitung Proses3734 19/<strong>03</strong>/2<strong>01</strong>2 800/56/DKPPLJ/2<strong>01</strong>2Plt. Kepala Dinas Kebersihan, Pertamanan danPemeliharaan Lampu Jalan Pemkab Musi BanyuasinProses3735 19/<strong>03</strong>/2<strong>01</strong>2 72/AU.2/III/AKPAR‐2<strong>01</strong>2 Direktur Akademi Pariwisata Medan Proses3736 19/<strong>03</strong>/2<strong>01</strong>2 25/2/KR.III/III/2<strong>01</strong>2 Badan Kepegawaian Negara Kantor Regional III Proses3737 19/<strong>03</strong>/2<strong>01</strong>2 800/533/III.15.SET/2<strong>01</strong>2 Dinas Kelautan dan Perikanan Pemprov. Lampung Proses3738 19/<strong>03</strong>/2<strong>01</strong>2 Um.002/91/23/DNG.MKS‐123739 19/<strong>03</strong>/2<strong>01</strong>2 551.11/181/DishubkominfoDistrik Navigasi Kelas I Makassar, Ditjend PerhubunganLaut, Kem. PerhubunganDinas Perhubungan, Komunikasi dan InformatikaPemkot BanjarmasinProsesProses3740 19/<strong>03</strong>/2<strong>01</strong>2 050/00466.A Plt. Sekretaris Daerah Pemkab Brebes Proses3741 19/<strong>03</strong>/2<strong>01</strong>2 144/Dir.<strong>01</strong>/2<strong>01</strong>2Direktur Utama Perusahaan Daerah Bank PerkreditanRakyat Badan Kredit Kecamatan Kab. JeparaProses3742 19/<strong>03</strong>/2<strong>01</strong>2 100/ASS II/Progdal/2<strong>01</strong>2/ Asisten Bidang Ekbang, Setda Pemkab Rokan Hilir Proses3743 19/<strong>03</strong>/2<strong>01</strong>2 S‐919/WKN.10/KNL.<strong>01</strong>/2<strong>01</strong>2Kantor Pelayanan Kekayaan Negara dan LelangSurabaya Kanwil X Surabaya Ditjend Kekayaan NegaraKementerian KeuanganProses3744 19/<strong>03</strong>/2<strong>01</strong>2 050/25/409.108/2<strong>01</strong>2 Bina Marga dan Pengairan Dinas PU Pemkab Blitar Proses3745 19/<strong>03</strong>/2<strong>01</strong>2 002.6/228/APP/2<strong>01</strong>2 Wakil Bupati Sumbawa ProsesHal 193

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3746 19/<strong>03</strong>/2<strong>01</strong>2 S‐199/WBC.05/KPP.MP.02/2<strong>01</strong>23747 19/<strong>03</strong>/2<strong>01</strong>2 S‐410/WBC.09/KPP.MC.02/2<strong>01</strong>2Plh. Kepala Kantor Pengawasan dan Pelayanan Beadan Cukai Tipe Madya Pabean B Jambi Kanwil DJBCSumatera Bagian Selatan Ditjend Bea dan CukaiKementerian KeuanganKepala Kantor Pengawasan dan Pelayanan Bea danCukai Tipe Madya Cukai Kudus Kanwil Jawa Tengahdan DIY Ditjend Bea dan Cukai Kementerian KeuanganProsesProses3748 19/<strong>03</strong>/2<strong>01</strong>2 870/BKD‐SET/152 Kepala Badan Kepegawaian Daerah Kab. Indra Giri Hilir Proses3749 19/<strong>03</strong>/2<strong>01</strong>2 Un.06.2/HM.00/339/2<strong>01</strong>2 Kabiro Administrasi Umum UIN Alauddin Makassar Proses3750 19/<strong>03</strong>/2<strong>01</strong>2 Kd.21.12/1/KP.07.2/422/2<strong>01</strong>2Kepala Kantor Kementerian Agama Kab. KepulauanSelayarProses3751 19/<strong>03</strong>/2<strong>01</strong>2 600/46/DPU/III/2<strong>01</strong>2 Kepala Dinas PU Pemkot Sabulussalam Proses3752 19/<strong>03</strong>/2<strong>01</strong>2 873.5/60/Diskebrum‐AdmPlt. Kepala Dinas Kebersihan dan Perumahan PemkotSingkawangProses3753 19/<strong>03</strong>/2<strong>01</strong>2 S.354/Set‐2/2<strong>01</strong>2 Setditjend Bina Usaha Kehutanan Proses3754 19/<strong>03</strong>/2<strong>01</strong>2 800/143/Dishutbun3755 19/<strong>03</strong>/2<strong>01</strong>2 S.1<strong>03</strong>/BPTH.Sum‐1/2<strong>01</strong>23756 19/<strong>03</strong>/2<strong>01</strong>2 477/1.795.su/2<strong>01</strong>2Dinas Kehutanan dan Perkebunan Pemkab.TasikmalayaBalai Perbenihan Tanaman Hutan SumateraKementerian KehutananKepala Sudin Pertamanan Kota Administrasi JakartaBaratProsesProsesProses3757 19/<strong>03</strong>/2<strong>01</strong>2 12/DST/PLP/III/2<strong>01</strong>2 Corporate Manager Diponegoro Smart Solution Proses3758 19/<strong>03</strong>/2<strong>01</strong>2 ‐ Kepala Dinas Tata Kota Dan Pariwisata Kota Metro Proses3759 19/<strong>03</strong>/2<strong>01</strong>2 050/71 Kepala Bappeda Kab. Supiori ProsesHal 194

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3760 19/<strong>03</strong>/2<strong>01</strong>2 PD.02<strong>03</strong>.C6/573 Direktur Penataan Bangunan dan Lingkungan Proses3761 19/<strong>03</strong>/2<strong>01</strong>2 150/144/2<strong>01</strong>2Kepala Dinas Cipta Karya dan Tata Kebersihan Kab.GroboganProses3762 19/<strong>03</strong>/2<strong>01</strong>2 050/Ad.Pemb/145 Asisten Ekbang & Kesra Setda Pemkab. Kampar Proses3763 19/<strong>03</strong>/2<strong>01</strong>2 12/0252‐2/DS/II/S‐16 PT. Dok Dan Perkapalan Surabaya (Persero) Proses3764 19/<strong>03</strong>/2<strong>01</strong>2 893.3/5<strong>03</strong>/418.64/2<strong>01</strong>2 Sekretaris Daerah Setda Pemkab. Kediri Proses3765 20/<strong>03</strong>/2<strong>01</strong>2 028/BLHSekv/0505 Kepala Bandan Lingkungan Hidup Prov. Jateng Proses3766 20/<strong>03</strong>/2<strong>01</strong>2 PL.3<strong>01</strong>/1/8/DJPD/2<strong>01</strong>2 Pelaksana Tugas Ditjen. Perhubungan Darat Proses3767 20/<strong>03</strong>/2<strong>01</strong>2 W.24‐U/329/UM.<strong>01</strong>.10/II/2<strong>01</strong>2 Panitera/Sekretaris Pengadilan Tinggi Denpasar Proses3768 20/<strong>03</strong>/2<strong>01</strong>2 ‐ Universitas Terbuka Proses3769 20/<strong>03</strong>/2<strong>01</strong>2 23/10/8744 Badan Pusat Statistik Proses3770 20/<strong>03</strong>/2<strong>01</strong>2 W.27.PAS.5.PL.02.<strong>03</strong>‐<strong>03</strong>33 Kepala Rutan Negara Kelas IIA Batam Proses3771 20/<strong>03</strong>/2<strong>01</strong>2 620/<strong>01</strong>77/Dis.PU Kepala Dinas Pekerjaan Umum Kab. Tolitoli Proses3772 20/<strong>03</strong>/2<strong>01</strong>2 045.2/28/1/DISHUBKOMINFO Kepala Dishub Kominfo Prov. Sumatera Selatan Proses3773 20/<strong>03</strong>/2<strong>01</strong>2 B.1221/BBPPK/III/2<strong>01</strong>2 Kepala Balai Besar Pengembangan dan Perluasa Kerja Proses3774 20/<strong>03</strong>/2<strong>01</strong>2 UM.0<strong>03</strong>/6/18/DNG.Bna‐12 Kepala Distrik Navigasi Kelas II Benoa Proses3775 20/<strong>03</strong>/2<strong>01</strong>2 092/UN34/LK/2<strong>01</strong>2 Wakil Rektor II Univ. Negeri Yogyakarta ProsesHal 195

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3776 20/<strong>03</strong>/2<strong>01</strong>2 1860/‐1.823.5Kepala Sudin. Peternakan Dan Perikanan JakartaSelatanProses3777 20/<strong>03</strong>/2<strong>01</strong>2 129/‐072 Kepala Puskesmas Kecamatan Jagakarsa Proses3778 20/<strong>03</strong>/2<strong>01</strong>2 S‐152/WKN.<strong>01</strong>/2<strong>01</strong>2 Kepala Ditjen Kekayaan Negara Kanwil I Banda Aceh Proses3779 21/<strong>03</strong>/2<strong>01</strong>2 D.202/LP.107/BPPP.P‐12 Kepala Balai Diklat Penerbangan Palembang Proses3780 21/<strong>03</strong>/2<strong>01</strong>2 800/0673/SetKepala Dinas Perindustrian Dan Perdagangan Pro.Sumatera utaraProses3781 21/<strong>03</strong>/2<strong>01</strong>2 002/LKI‐Konversi/III/2<strong>01</strong>2 Ketua Lembaga Kajian Indonesia Proses3782 21/<strong>03</strong>/2<strong>01</strong>2 440/000/580/UM‐Dinkes Kepala Dinas Kesehatan Kabupaten Sigi Proses3783 21/<strong>03</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.02‐Ar/98 Direktur Bina Operasi dan Pemeliharaan Proses3784 21/<strong>03</strong>/2<strong>01</strong>2 551.11/181/Dishubkominfo Kepala Dishubkominfo Kota Banjarmasin Proses3785 21/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>1/230/404.1.2.2./2<strong>01</strong>2 Sekretaris Daerah Setda Pemkab. Sidoarjo Proses3786 21/<strong>03</strong>/2<strong>01</strong>2 B/724/04/20/1/SET Kepala Biro Umum Lemhanas RI Proses3787 21/<strong>03</strong>/2<strong>01</strong>2 1978/‐1.823.5Kepala Sudin Peternakan Dan Perikanan JakartaSelatanProses3788 21/<strong>03</strong>/2<strong>01</strong>2 810/290/DINKES‐A Kepala Dinas Kesehatan Kab. Kubu Raya Proses3789 21/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/251 Sekretaris Daerah setda. Pemkab. Pekalongan Proses3790 21/<strong>03</strong>/2<strong>01</strong>2 S‐218/KPU.02/BG.<strong>01</strong>/2<strong>01</strong>23791 21/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/305/SekretPLH. Kepala Bagian Umum kantor Pelayanan UtamaBea Dan Cukai Tipe B BatamKepala Badan Keluarga Berencana Dan PemberdayaanPerempuan Kab. BandungProsesProsesHal 196

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3792 21/<strong>03</strong>/2<strong>01</strong>2 254/FTP‐UGM/LK/2<strong>01</strong>23793 21/<strong>03</strong>/2<strong>01</strong>2 In.08/R/Ks.<strong>01</strong>.1/724/2<strong>01</strong>2Kepala kantor Administrasi Fakultas TeknologiPertanian Univ. Gadjah MadaRektor institut Agama Islam Negeri Sulthan ThahaSaifuddin JambiProsesProses3794 21/<strong>03</strong>/2<strong>01</strong>2 660/093/BLHK‐BLG/2<strong>01</strong>1 Kepala BLHK Kab. Balangan Proses3795 21/<strong>03</strong>/2<strong>01</strong>2 ‐Kepala balai Konservasi Sumber Daya Alam KalimatanSelatanProses3796 21/<strong>03</strong>/2<strong>01</strong>2 In.04/I.5/KS.<strong>01</strong>/199/2<strong>01</strong>2 Kepala Biro AUAK Institut Agama Islam Negeri Antasari Proses3797 21/<strong>03</strong>/2<strong>01</strong>2 ‐Kabid. Pendidikan dan Pelatihan Badan Kepegawaiandaerah Pemkot. Bandar lampungProses3798 21/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/746‐BKPP Sekretaris Daerah Setda. Pemkot. Bogor Proses3799 21/<strong>03</strong>/2<strong>01</strong>2 893.5/146/set.Diperta/HSU/2<strong>01</strong>2Kepala Dinas Pertanian Tanaman Pangan danHortikultura kab. Hulu Sungai UtaraProses3800 22/<strong>03</strong>/2<strong>01</strong>2 ‐ Zuherdi Proses38<strong>01</strong> 22/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/<strong>03</strong>89/BU/2<strong>01</strong>2 Sekretaris Daerah Pemkab. Kotawaringin Timur Proses3802 22/<strong>03</strong>/2<strong>01</strong>2 890/444/II.10/TF/2<strong>01</strong>2Sekretaris Badan Pendidikan dan Latihan DaerahPemprov. LampungProses38<strong>03</strong> 22/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/0871/Perl/2<strong>01</strong>2 Sekretaris Daerah Pemkab. Jembrana Proses3804 22/<strong>03</strong>/2<strong>01</strong>2 S.249.a/RSUD.1.3.1/III/2<strong>01</strong>2 Dirut RSUD Raden Mattaher Prov. Jambi Proses3805 22/<strong>03</strong>/2<strong>01</strong>2 800/290 Kepala Dinas PU Pemkab. Manokwari Proses3806 22/<strong>03</strong>/2<strong>01</strong>2 S‐345/WPB.24/KP.0910*2<strong>01</strong>2Plh. Kepala Kantor Pelayanan Perbendaharaan NegaraSinjai Kanwil Sulsel Ditjend PerbendaharaanKementerian KeuanganProses3807 22/<strong>03</strong>/2<strong>01</strong>2 167/III/2<strong>01</strong>2 Camat Winong, Pemkab Pati ProsesHal 197

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3808 22/<strong>03</strong>/2<strong>01</strong>2 842/‐084Kepala Dinas Pengawasan dan Penertiban BangunanProv. DKI JakartaProses3809 22/<strong>03</strong>/2<strong>01</strong>2 286/‐077.1 Sekretaris Kota Administrasi Jakarta Selatan Proses3810 22/<strong>03</strong>/2<strong>01</strong>2 W32.FD.UM.<strong>01</strong>.<strong>01</strong>‐1423811 22/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/159/KepegKepala Kantor Imigrasi Klas II Mamuju Kanwil SulawesiBarat ‐ KemhukhamKepala Badan Kesatuan Bangsa Politik danPerlindungan masyarakat daerah Prov. Jawa BaratProsesProses3812 22/<strong>03</strong>/2<strong>01</strong>2 B/90/III/2<strong>01</strong>2/Rumkit RS Bhayangkara Palembang, Biddokkes Sumsel Proses3813 22/<strong>03</strong>/2<strong>01</strong>2 690.1/77/PDAM‐TP/III/2<strong>01</strong>2 PDAM Tirta Patriot Proses3814 22/<strong>03</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>03</strong>/Az/793815 22/<strong>03</strong>/2<strong>01</strong>2 LT.05/BPM‐PK/57/2<strong>01</strong>23816 22/<strong>03</strong>/2<strong>01</strong>2 800/12/Setdako/363/2<strong>01</strong>23817 22/<strong>03</strong>/2<strong>01</strong>2 560/963818 22/<strong>03</strong>/2<strong>01</strong>2 PL.1<strong>03</strong>/05/III/ATKP‐M/2<strong>01</strong>2Kepala Balai Besar Wilayah Sungai Cidanau ‐ Ciujung ‐CidurianKepala Badan Pemberdayaan Masyarakat DanPemrintahan Kelurahan, Pemkot ManadoKepala Bagian Umum dan Perlengkapan Setda KotaManadoKepala Dinas Sosial, Tenaga Kerja dan TransmigrasiPemkab. PekalonganDirektur Akademi Teknik dan KeselamatanPenerbangan Medan Badan Pengembangan SDMPerhubungan Kementerian PerhubunganProsesProsesProsesProsesProses3819 22/<strong>03</strong>/2<strong>01</strong>2 W4‐UM.<strong>03</strong>.<strong>01</strong>‐0656 Kepala Kanwil Kem. Hukum dan HAM Riau Proses3820 22/<strong>03</strong>/2<strong>01</strong>2 028/80/Sesprov.<strong>027</strong>/II/2<strong>01</strong>2Sekretaris Komisi Pemilihan Umum Prov. SulawesiTenggaraProses3821 26/<strong>03</strong>/2<strong>01</strong>2 42/DPU/III/2<strong>01</strong>2 Kepala Dinas PU Pemkab Jeneponto Proses3822 26/<strong>03</strong>/2<strong>01</strong>2 1668/BPSDMKP.<strong>01</strong>/TU.210/III/2<strong>01</strong>23823 26/<strong>03</strong>/2<strong>01</strong>2 W15‐DL.<strong>03</strong>.04‐20Sekretaris Badan Pengembangan SDM Kelautan danPerikanan, Kem. KPPlh. Kepala Kanwil Kementerian Hukum dan HAMSulawesi SelatanProsesProsesHal 198

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3824 26/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/821/2<strong>01</strong>23825 26/<strong>03</strong>/2<strong>01</strong>2 550/551/Dishub/2<strong>01</strong>2Kepala Dinas Kehutanan dan Perkebunan PemkabAceh UtaraKepala Dinas Perhubungan Pemkab KotawaringinTimurProsesProses3826 26/<strong>03</strong>/2<strong>01</strong>2 KW.19.1/3/KU.00.1/5<strong>03</strong>/2<strong>01</strong>2 Kepala Kanwil Kementerian Agama Prov. NTB Proses3827 26/<strong>03</strong>/2<strong>01</strong>2 136/D.18/Damkar/III/2<strong>01</strong>2 Plt. Kepala Dinas Pemadam Kebakaran Kota Manado Proses3828 26/<strong>03</strong>/2<strong>01</strong>2 440/12/Dinkes.<strong>01</strong> Sekretaris Dinas Kesehatan Pemkot Bontang Proses3829 26/<strong>03</strong>/2<strong>01</strong>2 849/372/Umpro.1 Sekretaris Daerah Pemkab Kutai Timur Proses3830 26/<strong>03</strong>/2<strong>01</strong>2 893.4‐A/1142/2<strong>01</strong>2 Kepala Dinas Pengairan Pemerintah Aceh Proses3831 26/<strong>03</strong>/2<strong>01</strong>2 521.32/5524/Sekr/III/2<strong>01</strong>2 Kepala Dinas Pertanian Prov. Sumatera Utara Proses3832 26/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/09/Setda‐ULP/2<strong>01</strong>2 Kepala ULP Setda Pemkab Tanah Bumbu Proses3833 26/<strong>03</strong>/2<strong>01</strong>2 600/168/DPU/2<strong>01</strong>2 Plt. Kepala Dinas PU Kab. Tanjung Jabung Timur Proses3834 26/<strong>03</strong>/2<strong>01</strong>2 080/246/Pemb Sekretaris Daerah Kota Parepare Proses3835 26/<strong>03</strong>/2<strong>01</strong>2 544.3/956/Dalprog Sekretaris Daerah Kab. Karawang Proses3836 26/<strong>03</strong>/2<strong>01</strong>2 522/206/DKPEKepala Dinas Kehutanan Pertambangan dan EnergiPemkab Sidenreng RappangProses3837 26/<strong>03</strong>/2<strong>01</strong>2 B/2551/III/2<strong>01</strong>2/Rosarpras Karo Sarpras Polda Bali Proses3838 26/<strong>03</strong>/2<strong>01</strong>2 S.799/SET‐3/2<strong>01</strong>2Sekretaris Ditjend BPDAS dan Perhutanan sosialKementerian KehutananProses3839 26/<strong>03</strong>/2<strong>01</strong>2 Kw.05.1/2/KP.02.3/1358/2<strong>01</strong>2 Kepala Kanwil Kementerian Agama Prov. Jambi ProsesHal 199

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3840 26/<strong>03</strong>/2<strong>01</strong>2 893.3/2<strong>03</strong>/2<strong>01</strong>2 Sekretaris DPRD Pemkab Karanganyar Proses3841 26/<strong>03</strong>/2<strong>01</strong>2 827/346/DispertasihKepala Dinas Perumahan, Penataan Ruang danKebersihan Kab. BandungProses3842 26/<strong>03</strong>/2<strong>01</strong>2 Pemb.<strong>027</strong>/861/III/2<strong>01</strong>2 Sekretaris Daerah Pemkab. Sumba Timur Proses3843 26/<strong>03</strong>/2<strong>01</strong>2 100/32/V/2<strong>01</strong>2 Sekretaris Daerah Pemkab Ogan Komering Ulu Selatan Proses3844 26/<strong>03</strong>/2<strong>01</strong>2 560/565/DTK‐TR/2<strong>01</strong>2 Kepala Disnakertrans Pemkab Deli Serdang Proses3845 26/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/319‐PK/2<strong>01</strong>2 Sekretaris Daerah Pemkot Cirebon Proses3846 26/<strong>03</strong>/2<strong>01</strong>2 525/414/Prog Kepala Dinas Perkebunan Pemprov. Sulawesi Selatan Proses3847 27/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/529/Sekr.Ro.Pemb Sekretaris Daerah Pemprov. Sulawesi Utara Proses3848 27/<strong>03</strong>/2<strong>01</strong>2 050/749/BLPBJ/2<strong>01</strong>2 Setda Pemkab Mandailing Natal Proses3849 27/<strong>03</strong>/2<strong>01</strong>2 076/Pemb/III/2<strong>01</strong>2 Sekretaris Daerah Kota Palopo Proses3850 27/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/316/III.2<strong>01</strong>2Badan Perpustakaan dan Arsip Daerah Pemprov.MalukuProses3851 27/<strong>03</strong>/2<strong>01</strong>2 050/759/419.61/2<strong>01</strong>2 Bappeda Pemkot Kediri Proses3852 27/<strong>03</strong>/2<strong>01</strong>2 Kd.10.<strong>01</strong>/1/KU.<strong>01</strong>.2/1383/2<strong>01</strong>2 Kepala Kantor Kementerian Agama kab. Bogor Proses3853 27/<strong>03</strong>/2<strong>01</strong>2 445/1743.Sekret Direktur RSU Kab. Tanggerang Proses3854 27/<strong>03</strong>/2<strong>01</strong>2 Kd.11.05/1/PP.00.1/0638/2<strong>01</strong>2 Kepala Kantor Kementerian Agama Kab. Kebumen Proses3855 28/<strong>03</strong>/2<strong>01</strong>2 800/245.1/Dinkes Kepala Dinkes Kab. Banggai ProsesHal 200

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3856 28/<strong>03</strong>/2<strong>01</strong>2 800/51.a/DPPKA/2<strong>01</strong>2Sekretaris Dinas Pendapatan, Pengelolaan KeuanganDan Aset Kab. BanggaiProses3857 28/<strong>03</strong>/2<strong>01</strong>2 ‐ Kepala Bappeda Kab. Banggai Proses3858 28/<strong>03</strong>/2<strong>01</strong>2 800/59/BPP‐KB/2<strong>01</strong>2Kepala Badan Pemberdayaan Perempuan Dan KB Kab.BanggaiProses3859 28/<strong>03</strong>/2<strong>01</strong>2 890/45/SH/II/2<strong>01</strong>2 Plt. Lurah Soho Pemkab. Banggai Proses3860 28/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/088‐DBMPSekretaris Dinas Bina Marga Dan Pengairan Pemkot.BandungProses3861 28/<strong>03</strong>/2<strong>01</strong>2 DIK.5.1/2870/III/2<strong>01</strong>2/Rosarpras Karo Sarpras Polda Jateng Proses3862 28/<strong>03</strong>/2<strong>01</strong>2 510/124/Disdik‐Kadis/II/2<strong>01</strong>2 Kepala Dinas Pendidikan Pemkab Kutai Timur Proses3863 28/<strong>03</strong>/2<strong>01</strong>2 600/179/DPU‐KT/III/2<strong>01</strong>2Sekretaris Dinas Pekerjaan Umum Pemkab. KutaiTimurProses3864 28/<strong>03</strong>/2<strong>01</strong>2 404/PPS.2/PL.420/III/2<strong>01</strong>2 Kepala Pelabuhan Perikanan Samudera Kendari Proses3865 28/<strong>03</strong>/2<strong>01</strong>2 B/248/III/2<strong>01</strong>2 Kepala Zeni Komando daerah Militer V/Brawijaya Proses3866 28/<strong>03</strong>/2<strong>01</strong>2 660/189/BLH/III/2<strong>01</strong>2 Kepala Badan Lingkungan Hidup Pemkot. Balikpapan Proses3867 28/<strong>03</strong>/2<strong>01</strong>2 UM.002/1/7/DNG.Dmi‐12 Kepala Distrik Navigasi Kelas I Dumai Proses3868 28/<strong>03</strong>/2<strong>01</strong>2 S‐139/WBC.16/KPP.<strong>01</strong>/2<strong>01</strong>23869 28/<strong>03</strong>/2<strong>01</strong>2 523/DPK/411/A/III/2<strong>01</strong>23870 28/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/563/BPAD/2<strong>01</strong>23871 28/<strong>03</strong>/2<strong>01</strong>2 446/DAGLU‐1.4/SD/3/2<strong>01</strong>2Kepala kantor Ditjen Bea Dan Cukai kanwil malukuPapuan Dan Papua BaratKepala Dinas Perikanan dan kelautan Pemprov.GorontaloSekretaris Badan Perpustakaan dan Arsip DaerahProvinsi Sulawesi SelatanPejabat Pembuat Komitmen Ditjen Perdagangan LuarNegeriProsesProsesProsesProsesHal 2<strong>01</strong>

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3872 28/<strong>03</strong>/2<strong>01</strong>2 800/1096/7.1/III/2<strong>01</strong>2Direktur Umum dan Keuangan RSUD Dr. H. AbdulMoeloek Pempropv LampungProses3873 28/<strong>03</strong>/2<strong>01</strong>2 893.3/672/35.73.4<strong>03</strong>/2<strong>01</strong>2 Kepala Badan kepegawaian Daerah Pemkot Malang Proses3874 28/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/494/<strong>01</strong>2.2 Sekretaris Daerah Setda Pemkot Salatiga Proses3875 28/<strong>03</strong>/2<strong>01</strong>2 678/RSUD‐LDP/JP/III/2<strong>01</strong>2 Hj. Syahruni, S.SI.MARS.Apt Proses3876 28/<strong>03</strong>/2<strong>01</strong>2 UM.0<strong>03</strong>/4/1/DNG.Trk‐12 Kepala Distrik Navigasi Kelas III Tarakan Proses3877 28/<strong>03</strong>/2<strong>01</strong>2 Un.05/DirekturLPPSH/PP.00.09/054/2<strong>01</strong>2Direktur Lembaga Penerangan Dan PenyuluhanSyariah Dan HukumProses3878 28/<strong>03</strong>/2<strong>01</strong>2 In.07/B.1b/KP.02.3/111/2<strong>01</strong>2 Ketua Pelaksana IAIN Sumatera Utara Proses3879 28/<strong>03</strong>/2<strong>01</strong>2 890/87/Diklat/2<strong>01</strong>2Kepala Badan kepegawaian Daerah Dan Pelatihan Kab.Aceh Barat DayaProses3880 28/<strong>03</strong>/2<strong>01</strong>2 W24.PR.<strong>01</strong>.04‐71 Kepala Kantor Wilayah NTB Kemen Kum Dan HAM RI Proses3881 28/<strong>03</strong>/2<strong>01</strong>2 530/DP2B/SP/III/2<strong>01</strong>2 Direktur Perbenihan Ditjen Perikanan Budidaya Proses3882 28/<strong>03</strong>/2<strong>01</strong>2 Kw.05.1/1/KP.02.3/1433/2<strong>01</strong>2Kabag Tata Usaha Kementrian Agama Kanwil Prov.JambiProses3883 28/<strong>03</strong>/2<strong>01</strong>2 080/250/Pemb Sekretaris Daerah Kota Setda Kota Parepare Proses3884 28/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/106/437.12/2<strong>01</strong>2 Asisten Pemerintahan dan Kesra Setda Pemkab Gresik Proses3885 28/<strong>03</strong>/2<strong>01</strong>2 /1‐35.25/III/2<strong>01</strong>2 Kepala Kantor Pertanahan Kab. Gresik Proses3886 28/<strong>03</strong>/2<strong>01</strong>2 893/79/413.023/2<strong>01</strong>2 Kepala Bagian Pembangunan Setda Pemkab Lamongan Proses3887 28/<strong>03</strong>/2<strong>01</strong>2 893/140/413.109/2<strong>01</strong>2 Kepala Dinas PU. Pengairan Kab. Lamongan ProsesHal 202

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3888 28/<strong>03</strong>/2<strong>01</strong>2 893/106/413.213/2<strong>01</strong>2Kepala Kantor Pengolahan Data Elektronik Kab.LamonganProses3889 28/<strong>03</strong>/2<strong>01</strong>2 157/PPNP/TU.110/III/2<strong>01</strong>2 Kepala Pelabuhan Perikanan Nusantara Prigi Proses3890 28/<strong>03</strong>/2<strong>01</strong>2 484/2‐35.100/VII/2<strong>01</strong>2 Kepala Kantor BPN Provinsi Jawa Timur Proses3891 29/<strong>03</strong>/2<strong>01</strong>2 10<strong>01</strong>/073.73Kepala Sudin Kesehatan Kota Administrasi JakartaPusatProses3892 29/<strong>03</strong>/2<strong>01</strong>2 65.28.1/ITJ.0/KU.510/III/2<strong>01</strong>2 Sekretaris Inspektorat Jendral KKP Proses3893 29/<strong>03</strong>/2<strong>01</strong>2 445/491/406.044/2<strong>01</strong>2 Direktur RSUD dr. Soedomo Trenggalek Proses3894 29/<strong>03</strong>/2<strong>01</strong>2 B‐829/N.4.2/Cu.1/04/2<strong>01</strong>2 Assiten Pembinaan Kejaksaan Tinggi Riau Pekanbaru Proses3895 29/<strong>03</strong>/2<strong>01</strong>2 B/168/II/2<strong>01</strong>2 Kadisdikal Mabes Angkatan Laut Proses3896 29/<strong>03</strong>/2<strong>01</strong>2 080/256/Pemb Plt. Sekretaris Daerah Kota Setda Kota Parepare Proses3897 29/<strong>03</strong>/2<strong>01</strong>2 S.302/SMK Kehut‐1/2<strong>01</strong>23898 29/<strong>03</strong>/2<strong>01</strong>2 W25.DL.<strong>03</strong>.<strong>03</strong>‐853899 29/<strong>03</strong>/2<strong>01</strong>2S‐61/LPKD‐FE UNSRAT/KKD‐KKDK/III/2<strong>01</strong>2Kepala Sekolah Menengah kejuruan KehutananBPPSDM Kehutanan kemenHutKepala Kantor Wilayah Sulawesi Tenggara Kemen Kumdan HAM RIKetua Lembaga Pengembangan Keuangan DaerahFakultas Ekonomi UnsratProsesProsesProses3900 29/<strong>03</strong>/2<strong>01</strong>2 277/LATTAS‐LS/III/2<strong>01</strong>2 Direktur Bina lembaga dan Sarana Pelatihan Kerja Proses39<strong>01</strong> 29/<strong>03</strong>/2<strong>01</strong>2 PL.<strong>01</strong>.<strong>01</strong>/II.1/212/2<strong>01</strong>2 Plh. Direktur Utama RSUP Fatmawati Proses3902 29/<strong>03</strong>/2<strong>01</strong>2 747/TU.1<strong>01</strong>/B3/2<strong>01</strong>2 Sekretaris Utama BKKBN Proses39<strong>03</strong> 29/<strong>03</strong>/2<strong>01</strong>2 UM.0<strong>03</strong>/8/5/DNG Bna‐12 Kepala Distrik Navigasi Kelas II Benoa ProsesHal 2<strong>03</strong>

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3904 29/<strong>03</strong>/2<strong>01</strong>2 800/0548‐UmpegDiskanlutSekretaris Dinas Perikanan Dan Kelautan Pemprov.Kalimantan SelatanProses3905 29/<strong>03</strong>/2<strong>01</strong>2 ‐ Hasan Hamid Proses3906 29/<strong>03</strong>/2<strong>01</strong>2 521/411/UM.<strong>027</strong>/III/2<strong>01</strong>23907 29/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/370/Dispertasih3908 30/<strong>03</strong>/2<strong>01</strong>2 063/J37/LL/2<strong>01</strong>23909 30/<strong>03</strong>/2<strong>01</strong>2 1168/UN11.LR/2<strong>01</strong>2Kepala Dinas Pertanian, Peternakan Dan PerikananKab. Barito TimurKepala Dinas Perumahan, Penataan Ruang danKebersihan Kab. BandungKetua Lembaga Penjamin Mutu Pendidikan ProvinsiKalimantan TimurPembantu Rektor II Univ. Syiah Kuala Darussalam,Banda AcehProsesProsesProsesProses3910 30/<strong>03</strong>/2<strong>01</strong>2 345/445/RSUD Poso/2<strong>01</strong>1 Direktur RSUD Poso Proses3911 30/<strong>03</strong>/2<strong>01</strong>2 900/275/DISHUBKOMINFO Kepala Dishubkominfo Pemprov. Sulawesi Tengah Proses3912 30/<strong>03</strong>/2<strong>01</strong>2 B‐58/Setneg/PPKK/KU/<strong>03</strong>/2<strong>01</strong>2 Plt. Direktur Keuangan dan Umum Sekneg. RI Proses3913 30/<strong>03</strong>/2<strong>01</strong>2 560/110/2<strong>01</strong>2Kepala Dinas Tenga Kerja dan Transmigrasi Kab.Halmahera SelatanProses3914 30/<strong>03</strong>/2<strong>01</strong>2 449/1159/PTSK‐DKS Kepala Dinas Kesehatan Kab. Sambas Proses3915 30/<strong>03</strong>/2<strong>01</strong>2 900.1<strong>03</strong>3/BPKAD/2<strong>01</strong>2 Plt. Kepala BPKAD Kab. Langkat Proses3916 30/<strong>03</strong>/2<strong>01</strong>2 800/465/2<strong>01</strong>2 Kepala Dinas Kelautan dan Perikanan Kab. Aceh Utara Proses3917 30/<strong>03</strong>/2<strong>01</strong>2 056/1.120 Sekretaris Daerah Setda Pemkot. Surakarta Proses3918 30/<strong>03</strong>/2<strong>01</strong>2 055/9<strong>01</strong>/416‐021.4/2<strong>01</strong>2 Plt. Sekretaris Daerah Setda. Pemkab. Mojokerto Proses3919 30/<strong>03</strong>/2<strong>01</strong>2 5<strong>03</strong>/622/Jamsarkes Kepala Dinas Kesehatan Kab. Kuningan ProsesHal 204

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3920 30/<strong>03</strong>/2<strong>01</strong>2 B/22/III/2<strong>01</strong>2 Deky Sumantri, ST Proses3921 30/<strong>03</strong>/2<strong>01</strong>2 DIK.5.6./2910/III/2<strong>01</strong>2/Rosarpras Karo Sarpras Polda Jawa Tengah Proses3922 30/<strong>03</strong>/2<strong>01</strong>2 890/165/BPM‐PB/III/2<strong>01</strong>2 Plh. Kepala BPM Pemprov. Papua Barat Proses3923 30/<strong>03</strong>/2<strong>01</strong>2 KW.16.1/1/KP.02.3/0757/2<strong>01</strong>2 Kepala Kem. Agama Kanwil. Kalimantan Timur Proses3924 30/<strong>03</strong>/2<strong>01</strong>2 UM.<strong>01</strong>.<strong>03</strong>/PPLP.58/1<strong>03</strong>/III‐2<strong>01</strong>2 Kepala Satker Pengembangan PLP Sumatera Barat Proses3925 30/<strong>03</strong>/2<strong>01</strong>2 <strong>027</strong>/000747/VI Wakil Walikota Palembang Proses3926 30/<strong>03</strong>/2<strong>01</strong>2 800/<strong>03</strong>4.1/Pemb Setda Kab. Paser Proses3927 02/04/2<strong>01</strong>2 445/1762/RSUD.PBM/III/2<strong>01</strong>2 Direktur RSUD Kota Prabumulih Proses3928 02/04/2<strong>01</strong>2 Ditjen Perhubungan Laut Proses3929 02/04/2<strong>01</strong>2 18/Keu/KR.III/2<strong>01</strong>2 Kepala Kantor Regional III BKN Proses3930 02/04/2<strong>01</strong>2 824/67/600/TU.UP/II/2<strong>01</strong>2 Kepala Dinas PU Kab. Lebong Proses3931 02/04/2<strong>01</strong>2 <strong>027</strong>/799/SekreKepala Badan Perpustakaan Dan Kearsipan DaerahJabarProses3932 02/04/2<strong>01</strong>2 800/1061/Kepeg/BP4KKP/2<strong>01</strong>2 Kepala BP4KKP Pemkab. Bekasi Proses3933 02/04/2<strong>01</strong>2 092/15.99/Diskes Kepala Dinas Kesehatan Povinsi Sulawesi Tengah Proses3934 02/04/2<strong>01</strong>2 Peg.800/385/2<strong>01</strong>2 Sekretaris Dinas Pengairan Dan ESDM kab. Aceh Utara Proses3935 02/04/2<strong>01</strong>2 800/624/BKD/2<strong>01</strong>2 Kepala badan Kepegawaian Dan Diklat Daerah ProsesHal 205

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3936 02/04/2<strong>01</strong>2 0520/‐089.51 Kepala Puskesmas Kec. Pulogadung Proses3937 02/04/2<strong>01</strong>2 523/DKP‐PWHT/A/142/III/2<strong>01</strong>2 Kepala Dinas Kelautan dan Perikanan Kab. Puwohato Proses3938 02/04/2<strong>01</strong>2 055/129/416‐108/2<strong>01</strong>2Kepala Dinas PU Cipta Karya & Tata Ruang Kab.MojokertoProses3939 02/04/2<strong>01</strong>2 069/UN7.ULP/KP/2<strong>01</strong>2 Ketua ULP Universitas Diponegoro Proses3940 02/04/2<strong>01</strong>2 W2.TUN7/248/PL.<strong>01</strong>/III/2<strong>01</strong>2Panitera Sekretaris Pengadilan Tata Usaha NegaraSerangProses3941 02/04/2<strong>01</strong>2 B/5<strong>03</strong>/III/2<strong>01</strong>2 Asiog TNI AD Kodam II/Sriwijaya Proses3942 02/04/2<strong>01</strong>2 292/J12.3.1/PS/2<strong>01</strong>2 Kepala P4TK Seni Budaya Proses3943 02/04/2<strong>01</strong>2 0412/OT.220/L.27.C/3/12Kepala Sub Bagian Tata Usaha Balai KarantinaPertanian Kelas II Tj. PinangProses3944 02/04/2<strong>01</strong>2 ‐ Kepala Biro Umum dan Keuangan <strong>LKPP</strong> Proses3945 02/04/2<strong>01</strong>2 622/D3.4/MN/2<strong>01</strong>23946 02/04/2<strong>01</strong>2 SM.3<strong>01</strong>/<strong>01</strong>/<strong>01</strong>/Upp.Ptb‐12Direktur Pembinaan SMK Ditjen. PendidikanMenengahKepala Kantor Unit Penyelenggara Pelabuhan PattiroBajoProsesProses3947 02/04/2<strong>01</strong>2 890/PU‐UPTJKSDM/672 Sekretaris Dinas PU Pemprov. Riau Proses3948 02/04/2<strong>01</strong>2 B/376/III/2<strong>01</strong>2 Direktur SDM dan Logistik Univ. Pertahanan Indonesia Proses3949 02/04/2<strong>01</strong>2 800/596/BPLH Kepala BPLH Pemkab Bandung Proses3950 02/04/2<strong>01</strong>2 <strong>027</strong>/884/Tamben‐II/2<strong>01</strong>2 Kepala Distamben Kab. Muara Enim Proses3951 <strong>03</strong>/04/2<strong>01</strong>2 893/2642Sekretaris Dinas Kehutanan Dan Perkebunan DI.YogyakartaProsesHal 206

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3952 <strong>03</strong>/04/2<strong>01</strong>2 AP.600/13/III/2<strong>01</strong>2 Asisten Ekonomi & Pembangunan Setda Pemkab. Belu Proses3953 <strong>03</strong>/04/2<strong>01</strong>2 B/422/III/2<strong>01</strong>2/Puskeu Kepala Pusat Keuangan POLRI Proses3954 <strong>03</strong>/04/2<strong>01</strong>2 74/BUA/KU.3/III/2<strong>01</strong>2Kepala Badan Urusan Administrasi Mahkamah AgungRIProses3955 <strong>03</strong>/04/2<strong>01</strong>2 193/D4/TU/2<strong>01</strong>2 Direktur Pembinaan PK‐LK Dikmen Proses3956 <strong>03</strong>/04/2<strong>01</strong>2 <strong>027</strong>/287/437.55/2<strong>01</strong>2 Kepala Dishub Kab. Gresik Proses3957 <strong>03</strong>/04/2<strong>01</strong>2 357/_077 Sekretaris Kota Administrasi Jakarta Selatan Proses3958 <strong>03</strong>/04/2<strong>01</strong>2 532/KPI.1/SD/3/2<strong>01</strong>2Sekretaris Ditjen Kerja Sama PerdaganganInternasionalProses3959 <strong>03</strong>/04/2<strong>01</strong>2 In.10/B.II/HM.<strong>01</strong>/456/2<strong>01</strong>2 Rektor IAIN Sultan Maulana Hasanuddin ‐ Banten Proses3960 <strong>03</strong>/04/2<strong>01</strong>2 810/654A/Dinkes Kepala Dinkes Kab. Bandung Proses3961 <strong>03</strong>/04/2<strong>01</strong>2 466/159/Kessos‐III/2<strong>01</strong>2 Kepala Dinkessos Pemkab. Lahat Proses3962 <strong>03</strong>/04/2<strong>01</strong>2 605.3/<strong>01</strong>2/IV/PD PAL Direktur PD PAL Pemkot Banjarmasin Proses3963 <strong>03</strong>/04/2<strong>01</strong>2 620/115/2<strong>01</strong>2 Kepala Dinas PU Pemprov. Papua Barat Proses3964 <strong>03</strong>/04/2<strong>01</strong>2 064/UN33.9/PM/2<strong>01</strong>2 Ketua LPM Universitas Negeri Medan Proses3965 04/04/2<strong>01</strong>2 06/IV/ST/2<strong>01</strong>2 Kepala Biro Ekbang Setda Sulawesi Barat Proses3966 04/04/2<strong>01</strong>2 <strong>027</strong>/0462/Bina Program/2<strong>01</strong>2 Sekretaris Daerah Kab. Karo Proses3967 04/04/2<strong>01</strong>2 005/LKI‐Konversi/VII/2<strong>01</strong>2 Ketua Lembaga Kajian Indonesia ProsesHal 207

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3968 04/04/2<strong>01</strong>2 310788/J19/LL/2<strong>01</strong>2 Kepala LPMP Prov. Sumatera Utara Proses3969 04/04/2<strong>01</strong>2 893/3513970 04/04/2<strong>01</strong>2 <strong>027</strong>/1696/PBDKepala Dinas Bina Marga dan Cipta Karya Pemkab.PidieKepala Biro Pengelolaan Barang Daerah Setda. JawaBaratProsesProses3971 04/04/2<strong>01</strong>2 <strong>027</strong>/1697/PBD Asisten Administrasi Setda. Jawa Barat Proses3972 04/04/2<strong>01</strong>2 028/635 Plh. Sekretaris Daerah Setda. Pemkab. Baubau Proses3973 04/04/2<strong>01</strong>2 800/357/2<strong>01</strong>2 Sekretaris Daerah Setda. Langsa Proses3974 04/04/2<strong>01</strong>2 800/25/ULP Sekretaris Daerah Setda.Pemkab. Ciamis Proses3975 04/04/2<strong>01</strong>2 Ma.02.09.15/PP.00.6/129/2<strong>01</strong>2 Kepala Madrasah Aliyah Negeri 15 Jakarta Proses3976 04/04/2<strong>01</strong>2 800259/DISHUBKOMINFO‐BS/2<strong>01</strong>2 Kepala Dishubkominfo Pemkab. Barito Selatan Proses3977 04/04/2<strong>01</strong>2 37/ST/DIKLIT/2<strong>01</strong>2 Direktur RSUD Arifin Achmad Pemprov. Riau Proses3978 04/04/2<strong>01</strong>2 600/337/Adm.PembKepala Biro Administrasi Pembangunan Setda Prov.NTBProses3979 04/04/2<strong>01</strong>2 <strong>027</strong>/460/404.6.3/2<strong>01</strong>2 Kepala BLH Kab. Sidoarjo Proses3980 05/04/2<strong>01</strong>2 B.<strong>01</strong>/BKU/III/2<strong>01</strong>2 Setjen Kementrian Tenaga Kerja dan Transmigrasi RI Proses3981 05/04/2<strong>01</strong>2 050/943/ADPAsisten Perekonomian dan Pembangunan Setda.Pemkab. Tanjung Jabung BaratProses3982 05/04/2<strong>01</strong>2 522/122 Kepala Dishutbun Pemkab. Gunung Kidul Proses3983 05/04/2<strong>01</strong>2 020/147/SETDA/UM‐C Sekretaris Daerah Kab. Kapuas Hulu ProsesHal 208

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>3984 05/04/2<strong>01</strong>2 045.2/12/2<strong>01</strong>2 Balai Pelaksana Teknis Bina Marga Wil. Pekalongan Proses3985 05/04/2<strong>01</strong>2 050/225/430.11.8/2<strong>01</strong>2 Direktur RSU Dr. H. Koesnadi Bondowoso Proses3986 05/04/2<strong>01</strong>2 UM0<strong>01</strong>/4/15/PLP.TPK‐123987 05/04/2<strong>01</strong>2 560/625Kepala Pangkalan Penjagaan Laut Dan Pantai Kelas ITajung PriokKepala Dinsos Naker dan Mobilitas Penduduk Kab.Aceh UtaraProsesProses3988 05/04/2<strong>01</strong>2 2852.24/125/04/2<strong>01</strong>2 Sekretaris Daerah Setda pemkab. Lampung Barat Proses3989 05/04/2<strong>01</strong>2 PD.<strong>01</strong>.04‐SL.08/71 Kepala Balai Diklat PU Wilayah VIII Banjarmasin Proses3990 05/04/2<strong>01</strong>2 0691/UN.30.6/JA/2<strong>01</strong>23991 05/04/2<strong>01</strong>2078/SPK‐LPKN/III/2<strong>01</strong>2 & 079/SPK‐LPKN/III/2<strong>01</strong>2Ketua Jurusan Akuntansi Fakultas Ekonomi Univ.BengkuluKetua Umum Lembaga Pengembangan & KonsultasiNasional (LPKN)ProsesProses3992 05/04/2<strong>01</strong>2 074/UN7.ULP/KP/2<strong>01</strong>2 Ketua ULP Universitas Diponegoro Proses3993 05/04/2<strong>01</strong>2 14.510.<strong>03</strong>29 Kepala Badan Pusat Statistik Prov. Riau Proses3994 05/04/2<strong>01</strong>2 28/<strong>03</strong>/2<strong>01</strong>2<strong>027</strong>/264/III/2<strong>01</strong>2/umum Setda Pemkab Mamuju Utara Proses3995 05/04/2<strong>01</strong>2 S.156/VI/BPPHP‐V/1/2<strong>01</strong>2Kepala Balai Pemantauan Pemanfaatan HutanProduksi Wilayah V Ditjend Bina Usaha KehutananKementerian KehutananProses3996 05/04/2<strong>01</strong>2 HAM1.UM.02.<strong>01</strong>‐681.a Setditjend Hak Asasi Manusia Kemhukham Proses3997 05/04/2<strong>01</strong>2 3102/‐084.3 Kepala Dinas Kesehatan Prov. DKI Jakarta Proses3998 02/08/2<strong>01</strong>1 523.<strong>027</strong>/827/PTKepala Dinas Kelautan dan Perikanan Prov.Kalimantan Barat3999 11/08/2<strong>01</strong>1 050/304/Bapp-Um/2<strong>01</strong>1 Kepala Bappeda dan Penanaman Modal Kab. Katingan4000 11/08/2<strong>01</strong>1 522/0/270/TU/VIII/2<strong>01</strong>1 Kepala Dinas Kehutanan Kab. KatinganHal 209

<strong>No</strong>TanggalTerimaProses<strong>No</strong>mor Surat Masuk Nama InstansiPencetakanSertifikat<strong>Pengiriman</strong> SertifikatKet<strong>Tgl</strong> <strong>Cetak</strong> <strong>Tgl</strong> <strong>Pengiriman</strong> <strong>No</strong>. <strong>RWB</strong>40<strong>01</strong> 25/07/2<strong>01</strong>1 335/VI/Minbang/LK-2<strong>01</strong>1 Sekretaris Daerah Kab. Lima Puluh KotaHal 210

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