395d RUS Form 395d - Results Of Equiptment Tests

OMB Control No. 0572-xxxx

Expiration Date: xx, 20xx

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 )