SIPANDU

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SIPANDU

Sistem Pengaduan Lingkungan Hidup

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Tanggal *

MM

/

DD

/

YYYY

Nama (Nama Asli sesuai KTP) *

Your answer

Alamat *

Your answer

NIK (Nomor Induk KTP)

Your answer

Nomor Telp/ HP *

Your answer

Pilihan Aduan *

Sampah

Limbah

Pencemaran Lingkungan (Air/ Udara)

Kerusakan Lingkungan

Other:

Alamat Aduan (Alamat Lengkap Lokasi Aduan) *

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Shareloc Aduan (Copy dan Paste dari Google Maps) *tidak wajib diisi

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Tulis Aduan *

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Dampak Aduan *

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Foto Lokasi Aduan (Upload foto menggunakan link di bawah ini)

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