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Control Engineering Laboratory Electrical Engineering Department Faculty of Industrial Technology Institut Teknologi Sepuluh Nopember EQUIPMENT REQUEST

FORM Name : ..Todays Date : ..//. Course : ..Days (Please Circle) Mo Tu We Th Fr Sa Su Date Needed : ./../.or Semester .(extended assignment) Room :.Start Time : : am/pm End Time : : am/pm

No

Equipments Code Name

Utilization

Remarks

Approved By

Confirmed By

Prepared By

Ir. Ali Fatoni, MT Head of Laboratory

Hanny Megawati Assistant

Muhammad Altway NIP/NRP. 2210100130

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