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QUALITY CONTROL USG FORM (DAILY/WEEKLY TEST)

Frequently Perform Test

Tool’s Namer :

Tubes Series Number :

License number of BAPETEN :

Period :

Control Type : Physical and Mechanical Inspection

Test Value
Name
Wheel and Scanner
No Date Of The Shift Tranducer Power Cord Control Video Monitor Duse Filter
Lock Housing
Officer
Ok Problem Ok Problem Ok Problem Ok Problem Ok Problem Ok Problem Ok Problem
If case of damage :

Date Event

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