<div class="row">
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      <div class="panel panel-lime">
          <div class="panel-heading">
              <div class="panel-heading-btn">
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              <a onclick="goBack()" class="btn btn-primary m-b-5"><span class="fa fa-arrow-left"></span> Kembali</a>
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              <div class="col-sm-10">
                <form class="form-horizontal" method="post" name="" action="">
                <input type="hidden" name="id_sampel" value="<?php echo (!empty($id_sampel) ? $id_sampel : null); ?>">
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Nomor Permintaan Uji</label>
                    <div class="col-md-7">
                        : 001
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Registrasi Laboratorium</label>
                    <div class="col-md-7">
                        : 01.01.2019P
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Tanggal/Pukul Pengembilan</label>
                    <div class="col-md-7">
                        : 07/01/2019 13.00 WIB
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Tanggal/Pukul Registrasi</label>
                    <div class="col-md-7">
                        : 07/01/2019 13.00 WIB
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Perkiraan Estimasi Selesai LHP</label>
                    <div class="col-md-7">
                        :
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Tanggal/Pukul Mulai Uji</label>
                    <div class="col-md-7">
                        : 1/8/2019 10/44 WIB
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Tanggal/Pukul Terbit LHU</label>
                    <div class="col-md-7">
                        : 1/16/2019 08.36 WIB
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Tanggal/Pukul Terbit LHP</label>
                    <div class="col-md-7">
                        : 1/17/2019 06/44 WIB
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Tanggal Surat</label>
                    <div class="col-md-7">
                        : 1/17/2019
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Nomor Surat</label>
                    <div class="col-md-7">
                        : 644
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Instansi</label>
                    <div class="col-md-7">
                        : PT. Agro Tek Mandiri Jaya
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Alamat</label>
                    <div class="col-md-7">
                        : Kutisari Selatan XI No. 9-11, Surabaya
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Nomor Telepon</label>
                    <div class="col-md-7">
                        : 081331777989
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Email Pengaju</label>
                    <div class="col-md-7">
                        : yohana.prihanto@gmail.com
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Nama Pengaju</label>
                    <div class="col-md-7">
                        : Bu Yohana
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Keterangan Instansi</label>
                    <div class="col-md-7">
                        : APBD
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Asal Sampel</label>
                    <div class="col-md-7">
                        : PT. Agro Tek Mandiri Jaya
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Nomor Sampel</label>
                    <div class="col-md-7">
                        : 001
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Jenis Sampel</label>
                    <div class="col-md-4">
                        : Pakan Cair Jagung (Basah)
                    </div>
                    <div class="col-md-4">
                        :
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Kualitas</label>
                    <div class="col-md-7">
                        : Baik
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Bentuk Jenis</label>
                    <div class="col-md-7">
                        : Cair
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Jenis Pengujian</label>
                    <div class="col-md-7">
                        : Proksimat, Ca, P
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Label Pakan</label>
                    <div class="col-md-7">
                        :
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Petugas Pengambilan Sampel</label>
                    <div class="col-md-7">
                        :
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Keterangan</label>
                    <div class="col-md-7">
                        : BPAT
                    </div>
                </div>
                <div class="form-group m-b-11">
                    <label class="col-md-4 col-form-label control-label">Kesimpulan</label>
                    <div class="col-md-7">
                        : NON PTM
                    </div>
                </div>

            </form>
            </div>
        </div>
      </div>
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