Your Name: ____________________________________________ Date: ___________________
Type of Machine: (circle one) Reader Reader/Printer
Machine Identification No.: (top of machine) _______________________
Location of Machine: (circle one) Search Room S&L Records Photolab
Describe Nature of Problem:
Please place form in Catherine Jellison's mailbox
| Date Inspected ________________ Repaired?: yes no | ||
| Status: working not working | ||
| Parts ordered ____/____/____ | ||
| Technician called ____/____/____ | ||
| Unrepairable ____/____/____ | ||
| Model # ___________________ | ||
| Quantity | Part # | Description |
rev. 2/16/99 /msa/refserv/forms/html/microfilmrepair.html