| No. | Nama | Paraf |
|---|---|---|
| 1 | UUN NUR WACHIT JAMALUDIN ROMDHONI | |
| 2 | YATNO | |
| 3 | ISTIANAH | |
| 4 | SUISDIYANTO | |
| 5 | SUBIYANTO | |
| 6 | DAHLAN AAN DWI WIDIYANTO | |
| 7 | SUNITI | |
| 8 | KASWADI | |
| 9 | SRI MURNI | |
| 10 | MUHTAROM | |
| 11 | DARTI | |
| 12 | AHMAD FARIKIN | |
| 13 | MUSIYONO | |
| 14 | SETIYOWATI | |
| 15 | EKO HANDRI NGATIMAN | |
| 16 | SITI MARYAM | |
| 17 | DIKA WAHYU KARTIKNO | |
| 18 | ROCHANI | |
| 19 | SUGIRI DWI ROHMAN | |
| 20 | SUPIYONO HAKIM | |
| 21 | TRIYONO |