POLITEKNIK NEGERI JAKARTA

WORK ORDER NO. A/C NO. CUSTOMER MODEL SERIAL NO. 1 WARRANTY
2 UNIT DOWN
3 SCHEDULED V

SEGMENT NO.

DELIVER TO. DATE/TIME OF CATERPILLAR PARTS ? INITIAL SUPPLY PSO REF. NO.
DELIVERY YES NO

CUSTOMER REPRESENTATIVE NAME CUSTOMER REPRESENTATIVE SIGNATURE TOTAL PARTS ESTIMATE

PREPARED BY APPROVED BY DATE/TIME 12 MEI,2000

APPROVED