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Object:
Operator:
Installer:
Street:
Street:
Town/Code:
Town/Code:
Phone:
Phone:
Fax:
Fax:
Handed over to:
Operating company or its representative)
Name
Signature
Site manager oft he installation
company:
Name
Signature
Location:
Date:
Next verification on:____________________ in 1year
Defects, irregularities and deviations from the checklist must be entered here.
Space for comments
Expert
Signature
Date
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