<fieldset>
<legend>EDIT RECEIVED ANALYSIS PURCHASE USED OIL</legend>
<form name="form1" method="post" action="<?php echo $form_action ?>" id="form1">
  <table width="100%" border="0" cellspacing="1" cellpadding="1">
    <tr>
      <td>JENIS PEMBAYARAN</td>
      <td>&nbsp;</td>
      <td><input name="qcair2" type="text" id="qcair2" size="10" maxlength="50" value="<?php echo set_value('qcair', isset($default['qcair']) ? $default['qcair'] : ''); ?>"  /></td>
      <td colspan="3">&nbsp;</td>
    </tr>
    <tr>
      <td colspan="3" align="center">========== KODE SAMPLE ==========</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td>1. Test Bahan Kimia</td>
      <td>:</td>
      <td><input name="qcair3" type="text" id="qcair3" size="10" maxlength="50" value="<?php echo set_value('qcair', isset($default['qcair']) ? $default['qcair'] : ''); ?>"  /></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td>2. kadar Pencemaran</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>Type</td>
      <td>:</td>
      <td><input name="qcair4" type="text" id="qcair4" size="10" maxlength="50" value="<?php echo set_value('qcair', isset($default['qcair']) ? $default['qcair'] : ''); ?>"  /></td>
    </tr>
    <tr>
      <td>- Air</td>
      <td>:</td>
      <td><input name="qcair" type="text" id="qcair" size="10" maxlength="50" value="<?php echo set_value('qcair', isset($default['qcair']) ? $default['qcair'] : ''); ?>"  /></td>
      <td>DO No.</td>
      <td>:</td>
      <td><input name="donumb" type="text" id="donumb" size="20" maxlength="50" value="<?php echo set_value('donumb', isset($default['donumb']) ? $default['donumb'] : ''); ?>"  />
        <font class="required">*</font></td>
    </tr>
    <tr>
      <td >- B. Bakar </td>
      <td>:</td>
      <td><input name="qcbakar" type="text" id="qcbakar" size="10" maxlength="50" value="<?php echo set_value('qcbakar', isset($default['qcbakar']) ? $default['qcbakar'] : ''); ?>"  /></td>
      <td>Manifest No.</td>
      <td>:</td>
      <td><label for="mnfst">
        <input name="mnfst" type="text" id="mnfst" size="20" maxlength="20" value="<?php echo set_value('mnfst', isset($default['mnfst']) ? $default['mnfst'] : ''); ?>"  />
        <font class="required">*</font></label></td>
    </tr>
    <tr>
      <td >- Residu</td>
      <td>:</td>
      <td><input name="qcresidu" type="text" id="qcresidu" size="10" maxlength="50" value="<?php echo set_value('qcresidu', isset($default['qcresidu']) ? $default['qcresidu'] : ''); ?>"  /></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td>3. Berat Jenis</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td>- T</td>
      <td>:</td>
      <td><input name="qct" type="text" id="qct" size="10" maxlength="50" value="<?php echo set_value('qct', isset($default['qct']) ? $default['qct'] : ''); ?>"  /></td>
      <td>Vehicle No.</td>
      <td>:</td>
      <td><input name="vnumb" type="text" id="vnumb" size="10" maxlength="50" readonly value="<?php echo set_value('vnumb', isset($default['vnumb']) ? $default['vnumb'] : ''); ?>"  />
        <font class="required">*</font></td>
    </tr>
    <tr>
      <?php /*?><td>Supplier ID</td>
      <td>:</td>
      <td><span class="primary">
        <input type="text" name="idsupp" id="idsupp" size="3" value="<?php ?>"  readonly="readonly" />
        <input type="text" name="nama_supp" size="15" id="nama_supp" value="<?php ?>"  readonly="readonly" />
        </span>
        <input type="button" name="button2" id="button2" value="..." class="button" onclick="window.open('<?php echo base_url();?>index.php/popup/popup_supp/','popuppage','width=900,height=600,scrollbar=yes,scrollbars=yes,top=100,left=100');" /></td><?php */?>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td width="19%">&nbsp;</td>
      <td width="1%">&nbsp;</td>
      <td width="27%">&nbsp;</td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td><input type="submit" name="button" id="button" value="Submit" class="button" /></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
  </table>
</form>
<?php

if ( ! empty($link))
	{
		echo '<p id="bottom_link">';
		foreach($link as $links)
		{
			echo $links . ' ';
		}
		echo '</p>';
	}
$this->load->view('includes/footer.php');
	?>
