Form II
Regular maintenance form
1
section: Regular maintenance operation
st
Maintenance provided
Qualified technician name
Specialized company name
Maintenance day
Signature
1
section: Regular maintenance operation
st
Maintenance provided
Qualified technician name
Specialized company name
Maintenance day
Signature
1
section: Regular maintenance operation
st
Maintenance provided
Qualified technician name
Specialized company name
Maintenance day
Signature
*
Compilation and signing of this form by the technician means the perfect functionality of the
dispenser has been tested
26