| IDENTITAS IDUKA | |
| Nama IDUKA | : Bengkel Bubut Dan Las Usaha Jaya Mandiri |
| Alamat IDUKA | : Jl. Martadinata No.89, Lumpur, Kemuteran, Kec. Gresik, Kabupaten Gresik, Jawa Timur 61151 |
| Pelaksanaan | : 13 Oktober 2025 s/d 13 Februari 2026 |
| Nama Direktur/ Pimpinan *) | : ........................................................................ |
| Nama Pembimbing *) | : ........................................................................ |
| No HP/ WA Pembimbing | : ........................................................................ |
| IDENTITAS PESERTA | |
| Nama Siswa | : WAHYU PRASETYO / XII TPm |
| HP Siswa | : 085732822580 |
| HP Orangtua | : 085812478793 |
| No | Tanggal Kunjungan | Uraian Kegiatan | Catatan | Paraf/stempel Pembimbing IDUKA | Petugas Monitoring |
| 1 | |||||
| 2 | |||||
| 3 |
| Hasil Pelaksanaan PKL :
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| Panitia PKL .................... NBM : |