Tube 1 Tube 2
Merk Merk
Tipe Tipe
No. Seri No. Seri
2 Kontrol keyboard
3 Bed
4 kolimasi
5 Penggerak mekanik
7 Probe / Tranduser
Catatan :
Padalarang, ..............................20
Mengetahui, dilaksanakan oleh,
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Bagian...................................