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HYDRANT INSPECTION FORM

FORM INSPEKSI HYDRANT
Tahun Lokasi Cikupa
Tgl / Bulan Inspector

Item check
Condition
Type
No Reg. No Lokasi Remark
(In/Out) Box W.I Hydrant Pillar Water
TAG NOZZLE HOSE (OK/NG)
Hydrant Hydrant (Key)** Check

2
3
4
5
6
7
8

9
10
11
12
13
14
20

Note
OK : Bagus
NG : Tidak Bagus HSE Dept Inspector

F.007.QH.005 Rev.0
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Item check
Condition
Type
No Reg. No Lokasi Remark
(In/Out) Box W.I Hydrant Pillar Water
TAG NOZZLE HOSE (OK/NG)
Hydrant Hydrant (Key)** Check

TA : Tidak Ada

F.007.QH.005 Rev.0