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i <br /> I <br /> I <br /> ' I <br /> � r1Bf�?1 ��?'ll�la l 9 'c 'l �?' a�6° .® l� Site Name: �3 ceg <br /> Address: <br /> #Snl� ;y (l ei Log city: _ t <br /> Date/i"im a I� <br /> DataMme Component .Date rime Technician Information Type of <br /> Date of Name Affiliation,Phone Service Type of Service Performed andthe <br /> Problem Removed Service Cali a yP <br /> Detected' from Made' Service Number and Certificati®n (Repair or ISD Outcome <br /> Service Number' Ala <br /> t,tL CM00 a t&NC,1_® (5C e'() E= <br /> L%1.011 Rhe <br /> I <br /> •� _o� 4„* u� .��,c:' 7 L' { (��, fir-- yly "�k-�-- �`(]�✓c l'd�'�` C�:,•�- �•`�:.� [t�:6� I <br /> ��� pcC 57 5 ` rf. �ilCL e(ec�;�',-y+ <br /> 55Ae C ovt C� �vvlt- JLA� � � V2 c,iF <br /> �� �`•l� �" � 3 � �'l�' � ��h_\ L�caie <br /> n L l�l I U�`• � l,�' <br /> Record date and time the problem was detected. Include equipment defects or ISD alarms. <br /> ?Record date and time component was taken out of service, it applicable. <br /> 3Record date and time the service call was made, M 0 C <br /> "Record date and time service was performed, q <br /> 511ecord certified repair technician's name, company affiliation, phone number and certification number,from apilicable manufacturer. Z <br /> sRecord the nature of the service call(repair or replace a component or respond to iSD alarm). Include ISD alarm type, if applicable, <br /> 7Record brief explanation of service performed, including outcome of service (repaired, tested and returned to service,wafting for parts, etc), Any all ac rts talc to <br /> identify the cause of an ISD alaran, including (fie actual results of tests performed in accordance with the I®8111 requirements 6or that alarm O ma0e <br /> attached), srnast also be noted, here or in supporting docum eats. o <br /> i <br /> i <br />