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ACTA DE CONTROL METROLGICO N ___________

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DATOS GENERALES
NOMBRE DEL RESPONSABLE DEL CONTROL:
CONTROL: _____________________________________________________________________________________
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FECHA: _________________________
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________ HORA INICIO: _____________________
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_________ HORA FIN:
FIN: ________
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NOMBRE DEL GRIFO/EE.SS.:


GRIFO/EE.SS.: _________________________________________________________________________
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________________________________________________________________
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NOMBRE COMERCIAL:
COMERCIAL: _________________________
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________________________ BANDERA: ______________________________
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DIRECCIN: __________________________________________________________________________________________________
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DEPARTAMENTO / PROVINCIA / DISTRITO:


DISTRITO: _____________________________________________________________________
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DATOS DEL MEDIDOR VOLUMTRICO PATRN (MVP)


MARCA: SERAPHIN PROPIETARIO: _____________________________________ N PRECINTO: ___________________________

VALOR DE CADA DIVISION DE LA ESCALA (%): ________________________________________________________________________________________


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N CERTIFICADO
CERTIFICADO DE CALIBRACIN MVP: ________________________________________________________________________________________________
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DATOS DEL CONTROL REALIZADO

N SURTIDOR/DISPENSADOR

NOMBRE DEL PRODUCTO

VOLUMEN DESPACHADO (GL) 05 GL 05 GL 05 GL


LINEAS CAUDAL MXIMO ()

ERROR CAUDAL MXIMO (%)

LINEAS CAUDAL MNIMO ()

ERROR CAUDAL MNIMO (%)

TOLERANCIA PERMITIDA (%) 0.5 % 0.5 % 0.5 %

OBSERVACIONES
OBSERVACIONES
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FIRMA DEL RESPONSABLE

DEL CONTROL

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