## Department Issue Report

Date of Request: | Data here ------ |  |  | BARCODE HERE
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Date on Material Needed: | Data here |  |
Department: | Dpartment |  |

ITEM | Description | Specification/Model | Part # /Sr# Number | Qty | Remarks
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Request Dept. Incharge | ____________ |  | Approved By | ___________
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#### Note :
Remarks Here

Call us: |  | Fax |  | Email |

Prepared by |  |  |  | Date Time |