395d Results of Acceptance Test

New Equipment Contract (Form 395) for Telecommunications and Broadband Borrowers

Form 395d(04-11-12) 1-2-13

New Equipment Contract (Form 395) for Telecommunications and Broadband Borrowers

OMB: 0572-0149

Document [docx]
Download: docx | pdf

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0572-NEW. The time required to complete this information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.



U S DEPARTMENT OF AGRICULTURE

RURAL UTILITIES SERVICE


RESULTS OF EQUIPMENT

ACCEPTANCE TESTS


DATE


BORROWER DESIGNATION


INSTRUCTIONS - Borrower's engineer will prepare 2 copies for each project on completion of the acceptance tests and distribute 1 copy to borrower & I copy to installer

PROJECT


SELLER


A.

COMPLETE THIS SECTION IF DISCREPANCIES WERE FOUND DURING TESTS.


1. THE FOLLOWING DISCREPANCIES WERE FOUND AND HAVE BEEN CORRECTED: (List below or on attached sheet)











2. THE FOLLOWING FOUND DISCREPANCIES HAVE NOT BEEN CORRECTED: (List below or on an attached sheet)



















NAME OF SELLER



NAME OF ENGINEERING COMPANY








By



By




SIGNATURE OF INSTALLER



SIGNATURE OF ENGINEER



B.

COMPLETE THIS SECTION IF NO DISCREPANCIES WERE FOUND DURING TESTS


1. THE EQUIPMENT MEETS THE REQUIREMENTS OF THE RUS ACCEPTANCE TESTS:















NAME OF SELLER



NAME OF ENGINEERING COMPANY








By



By




SIGNATURE OF INSTALLER



SIGNATURE OF ENGINEER






RUS FORM 395d (Issued )

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleDEPARTMENT OF AGRICULTURE
Authornorberto.esteves
File Modified0000-00-00
File Created2021-01-28

© 2024 OMB.report | Privacy Policy