CALIBRATION AND REPAIR REQUIREMENTS WORKSHEET

For use of this form, see TB 750-25, the proponent agency is USAMC
1. FROM (Customer Address)
2. DATE (YYYYMMDD)
3. REQUESTED ACTION
4a. REQUESTOR'S NAME
4b. PERSONNEL TYPE
4c. REQUESTOR'S ORGANIZATION / UIC
4d. REQUESTOR'S EMAIL ADDRESS
4e. REQUESTOR'S PHONE NUMBER
5a. ALTERNATIVE POC NAME
5b. PERSONNEL TYPE
5c. ALTERNATE'S ORGANIZATION / UIC
5d. ALTERNATE'S EMAIL ADDRESS
5e. ALTERNATE'S PHONE NUMBER

ITEM INFORMATION
6. NATIONAL STOCK NUMBER
7. MANUFACTURER
8. MODEL NUMBER
9. ITEM DESCRIPTION
10. DID A PEO / PD AUTHORIZE THIS PURCHASE?

a. If yes, what organization purchased and fielded this item?


b. If no, what organization authorized purchase?
 11. WAS THE PREFERRED ITEMS LIST (PIL) CHECKED BEFORE PURCHASING THIS ITEM?

12. WHAT WEAPON SYSTEM / PLATFORM WILL THE ITEM BE USED FOR?
 13. LOCATION(S) THIS ITEM WILL BE FIELDED TO?
14. QUANTITY OF ITEMS ORDERED / FIELDED?
 15. DO YOU HAVE CALIBRATION PROCEDURES AND OEM MANUALS?
16. IS THIS ITEM IN THE TB 43-180?

17. REMARKS
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