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Barcode number
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Lab code number
Sampling date
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Analysis program
Contact details
Company
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Contact
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Street + house number
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Postcode
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Town/City
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Country
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Telephone number
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E-mail address
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Customer number
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Lubricant
Brand
(*)
Type
(*)
ISO/SAE/NLGI
(*)
Period of use of lubricant
Km
Hours
Total period of use of equipment
Km
Hours
System volume (litres)
Added (litres)
Material
Brand
(*)
Type
(*)
Component
Registration number
Vehicle
Stationary machine
Engine
- select -
Petrol
Diesel
Gas engine - natural gas
Gas engine - biogas
Landfill gas
Biodiesel
Transmission/Drive system
- select -
Manual transmission
Automatic transmission
Front differential
Rear differential
Transfer box
Hub reduction
Reduction gearbox
Hydraulics
- Type pump -
Vane
Piston
Screw
- Valve type -
Proportional
Servo
Verification question : 17 + 0 = ?
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Simply enter the result of the addition. For example: 1 + 3 =
4
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