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Dokumen mencantumkan daftar dampak lingkungan yang terjadi dan rencana kegiatan pengelolaan serta pemantauan dampak tersebut. Penyataan ditandatangani, diberi materai, dan disertai stempel, serta menyatakan kesediaan untuk pelaksanaan dan pengawasan oleh instansi berwenang, lengkap dengan bagian tanggal.",{"@graph":63,"@context":120},[64,81,103],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,72,75,78],{"item":68,"name":69,"@type":70,"position":71},"https://docshare.wps.com","Home","ListItem",1,{"item":73,"name":9,"@type":70,"position":74},"https://docshare.wps.com/id/document/",2,{"item":76,"name":27,"@type":70,"position":77},"https://docshare.wps.com/id/document/layanan-kesehatan/",3,{"item":79,"name":59,"@type":70,"position":80},"https://docshare.wps.com/id/document/environmental-management-and-monitoring-capability-declaration-letter-sppl-declaration-form/229052/",4,{"url":79,"name":59,"@type":82,"image":83,"author":88,"headline":59,"publisher":91,"fileFormat":94,"inLanguage":57,"description":61,"dateModified":95,"datePublished":96,"encodingFormat":94,"isAccessibleForFree":97,"interactionStatistic":98},"DigitalDocument",{"url":84,"@type":85,"width":86,"height":87},"https://docshare.wps.com/thumbnails/environmental-management-and-monitoring-capability-declaration-letter-sppl-declaration-form/229052.png","ImageObject",300,407,{"name":89,"@type":90},"Eliana","Person",{"url":68,"name":92,"@type":93},"DocShare","Organization","application/pdf","2026-09-29","2026-09-10",true,{"@type":99,"interactionType":100,"userInteractionCount":102},"InteractionCounter",{"@type":101},"ViewAction",8,{"@type":104,"mainEntity":105},"FAQPage",[106,112,116],{"name":107,"@type":108,"acceptedAnswer":109},"Siapa saja yang perlu dicantumkan dalam SPPL ini?","Question",{"text":110,"@type":111},"SPPL mencantumkan identitas penanggung jawab (nama, jabatan, alamat, nomor telepon) dan identitas perusahaan/usaha (nama, alamat, nomor telepon, jenis usaha, kapasitas produksi).","Answer",{"name":113,"@type":108,"acceptedAnswer":114},"Apa yang harus diisi pada bagian dampak lingkungan yang terjadi?",{"text":115,"@type":111},"Bagian tersebut meminta daftar dampak lingkungan yang terjadi, ditulis bernomor (1, 2, 3, dst.).",{"name":117,"@type":108,"acceptedAnswer":118},"Bagaimana cara menyatakan kesanggupan dan pengesahan dokumen?",{"text":119,"@type":111},"Dokumen menyatakan kesediaan untuk melaksanakan pengelolaan dan pemantauan sesuai rencana serta bersedia diawasi instansi berwenang, lalu ditandatangani, diberi materai, dan distempel, disertai tanggal.","https://schema.org",{"og:url":79,"og:type":122,"og:title":59,"og:site_name":92,"og:description":61},"article",{"robots":124,"canonical":79},"index,follow",{"doc_id":126,"site_id":56},229052,1789035295,{"code":4,"msg":5,"data":129},{"doc_id":126,"user_id":130,"nickname":89,"user_avatar":131,"doc_module":4,"category_id":26,"category_name":27,"doc_title":59,"doc_description":61,"doc_content":132,"file_id":133,"file_url":134,"file_type":135,"file_size":136,"view_count":102,"is_deleted":4,"is_public":71,"is_downloadable":71,"audit_status":71,"page_count":74,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":127,"read_time":77},4398048949847,"https://ap-avatar.wpscdn.com/avatar/400002536579ef2da7f?_k=1778318612642679267","SURAT PERNYATAAN KESANGGUPAN PENGELOLAAN DAN PEMANTAUAN LINGKUNGAN  \nHIDUP (SPPL)  \nKami yang bertanda tangan dibawah ini :  \n􀂅 Nama :    \n􀂅 Jabatan :    \n􀂅 Alamat :    \n􀂅 Nomor Telepon :    \nSelaku penanggung jawab atas pengelolaan lingkungan dari :  \n􀂅 Nama Perusahaan / Usaha :    \n􀂅 Alamat Perusahaan / Usaha :    \n􀂅 Nomor Telepon Perusahaan :    \n􀂅 Jenis Usaha / Sifat Usaha :    \n􀂅 Kapasitas Produksi :    \nDengan dampak lingkungan yang terjadi berupa :  \n1    \n2    \n3    \n4    \n5   dst  \nMerencanakan untuk melakukan pengelolaan dan pemantauan dampak lingkungan melalui :  \n1    \n2    \n3    \n4    \n5   dst  \nPada prinsipnya bersedia untuk dengan sungguh-sungguh untuk melaksanakan seluruh pengelolaan dan pemantauan dampak lingkungan sebagaimana tersebut diatas, dan bersediauntuk diawasi oleh instansi yang berwenang  \nTanggal, bulan, tahun Yang menyatakan,  \nMaterai ,Tanda tangan, Stempel  \n(……….NAMA……………)  \n\n| Nomor Bukti Penerimaan oleh PTSP Provinsi DKI Jakarta |  |\n| --- | --- |\n| Tanggal |  |\n| Penerima | Kepala Kantor PTSP Kota / Kabupaten\u003Cbr>Tanda tangan dan Stempel\u003Cbr>(………….Nama…………….) NIP. |","cbCait1QaV2KwZv9","https://ap.wps.com/l/cbCait1QaV2KwZv9","pdf",78693,"Indonesian","# Surat Pernyataan Kesanggupan Pengelolaan dan Pemantauan Lingkungan Hidup (SPPL)\n## Identitas Penanggung Jawab dan Perusahaan/Usaha\n## Daftar Dampak Lingkungan dan Rencana Pengelolaan & Pemantauan\n## Pernyataan, Tanda Tangan, Materai, Stempel, dan Tanggal\n## Bukti Penerimaan oleh PTSP Provinsi DKI Jakarta","[{\"question\":\"Siapa saja yang perlu dicantumkan dalam SPPL ini?\",\"answer\":\"SPPL mencantumkan identitas penanggung jawab (nama, jabatan, alamat, nomor telepon) dan identitas perusahaan/usaha (nama, alamat, nomor telepon, jenis usaha, kapasitas produksi).\"},{\"question\":\"Apa yang harus diisi pada bagian dampak lingkungan yang terjadi?\",\"answer\":\"Bagian tersebut meminta daftar dampak lingkungan yang terjadi, ditulis bernomor (1, 2, 3, dst.).\"},{\"question\":\"Bagaimana cara menyatakan kesanggupan dan pengesahan dokumen?\",\"answer\":\"Dokumen menyatakan kesediaan untuk melaksanakan pengelolaan dan pemantauan sesuai rencana serta bersedia diawasi instansi berwenang, lalu ditandatangani, diberi materai, dan distempel, disertai tanggal.\"}]","SURAT PERNYATAAN KESANGGUPAN PENGELOLAAN DAN PEMANTAUAN LINGKUNGAN HIDUP (SPPL) - Formulir Pernyataan Pengelolaan dan Pemantauan | PDF"]