| No | No Samb | Nama | Alamat | Tarif Lama | Rekomendasi | Ket | Catatan | TTD | Foto |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 029954 | FATONAH | JL.MOJOSANTRI NO 15 RT 1 RW 7 | B1 | B1 | | |||
| 2 | 029953 | KHARIS TRI LAKSONO | JL.MOJOMULYO RT 22 RW 1 | B1 | B1 | | |||
| 3 | 025630 | KISMANU | JLN MOJOMULYO RT.3 RW.1 | B2 | B4 | | |||
| 4 | 029957 | KUKUH KURNIAWAN | JL.RAYA MOJOREJO.NO.12 RT 18 RW 8 | B1 | B1 | | |||
| 5 | 025633 | KUNARI | JL.MOJOMULYO RT.22 RW.1 | B2 | B2 | | |||
| 6 | 032809 | LINA WIDIANA | JL. MOJOASRI GG SALON DIVA NO. 26 | B1 | B1 | | |||
| 7 | 030754 | LISWANTO | JL MOJOWANGI 125 | B1 | B2 | | |||
| 8 | 029960 | SERIKASMIATI | JLN MOJOSANTRI RT 1 RW 7 | B1 | B1 | | |||
| 9 | 025634 | SUJONO | JL.MOJOMULYO RT.22 RW.1 | B2 | B2 | |
Mengetahui,
Kabag Hublang & Pemasaran
Menyetujui,
Kabag Teknik