BM01/QT02/QT

B TI NGUYN V MI TRNG
TRNG I HC TI NGUYN V MI TRNG
TP. H CH MINH

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
TP. H Ch Minh, ngy.thng ..nm 20

GIY NGH MN THIT B

Knh gi: ..
Ti l:---------------------------------------------------------------------------------------------------n v: -------------------------------------------------------------------------------------------------a ch:--------------------------------------------------------------------------------------------------Knh ngh Hiu trng duyt cho mn vt t thit b vi chng loi v s lng nh sau:
STT

Tn vt t, thit b

Chng loi

VT

S lng

Ghi ch

Thi gian mn t ngy ././20 n ngy ..//20.

Chng ti c trch nhim bn qun trong qu trnh s dng v hon tr nguyn trng.
Ngi ngh

PTP. Qun tr

Trng n v

n v QLTS trc tip

Hiu trng duyt