YAYASAN
INSAN INDONESIA MANDIRI
LABORATORIUM
MATEMATIKA
Jl. Raya Benowo No 1 -3 ,Tlp. (031 ) 7413061 -
7404404 Fax. 7404404 Surabaya
LEMBAR
PEMINJAMAN BARANG
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TANGGAL PEMINJAMAN
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TANGGAL PENGEMBALIAN
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TTD PENGEMBALIAN
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1
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11
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Surabaya,…………………20…
Mengetahui
Peminjam
Guru Matapelajaran
(……………………….)
(……………………………)
