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Pemeriksaan plemis
(tarikh) (masa)

2, Status kerja-kerja pembinaan ditapak:

[] Betum bina

t] Tehhbina

3. PendaftaranfailMDM:P/S-

4. Semakan
tl Sepertidi pelan

tl Bercanggah

5. Syor

l-l ut,,

(Tandatangan)
(Tarikh)

3 daipada 5

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