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<DIV align=center><FONT size=5><STRONG><BR>设备故障维护工作申请单<BR><BR></STRONG></FONT></DIV>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>故障设备工作项目</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_1}</FONT></DIV></TD></TR>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>故障日期</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_2}{OTHER_1}</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>期望维护或完工日期</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_3}{OTHER_2}</FONT></DIV></TD></TR>
<TR style="MIN-HEIGHT: 150px">
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<DIV style="LINE-HEIGHT: 2" align=center><FONT style="FONT-SIZE: 11pt" face=宋体>故障状况或</FONT></DIV>
<DIV style="LINE-HEIGHT: 2" align=center><FONT style="FONT-SIZE: 11pt" face=宋体>工作说明</FONT></DIV></TD>
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<DIV style="LINE-HEIGHT: 1.5"><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_4}</FONT></DIV></TD></TR>
<TR style="MIN-HEIGHT: 81px">
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>工务单位</FONT></DIV></TD>
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<DIV style="LINE-HEIGHT: 1.5"><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_5}</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>申请单位</FONT></DIV></TD>
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<DIV style="LINE-HEIGHT: 1.5"><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_7}</FONT></DIV></TD></TR>
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<DIV align=right><FONT style="FONT-SIZE: 11pt" face=宋体>主管签字：{DATA_6}</FONT></DIV></TD>
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<DIV align=right><FONT style="FONT-SIZE: 11pt" face=宋体>主管签字：{DATA_8}</FONT></DIV></TD></TR>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>成本记录</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>开始日期</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>完工日期</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>总工时</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>折算工资</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>材料费用</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>分摊费用</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>总成本</FONT></DIV></TD></TR>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>估计</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_9}{OTHER_3}</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_10}{OTHER_4}</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_11}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_12}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_13}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_14}</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_15}</FONT></DIV></TD></TR>
<TR style="MIN-HEIGHT: 35px">
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>实际</FONT></DIV></TD>
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<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_16}{OTHER_5}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: #000000 1.5pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_17}{OTHER_6}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: #000000 1.5pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_18}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: #000000 1.5pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_19}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: #000000 1.5pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_20}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: #000000 1.5pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_21}</FONT></DIV></TD>
<TD style="BORDER-BOTTOM: #000000 1.5pt solid; BORDER-LEFT: black 1pt solid; PADDING-BOTTOM: 1px; PADDING-LEFT: 1px; PADDING-RIGHT: 1px; VERTICAL-ALIGN: middle; BORDER-TOP: black 1pt solid; BORDER-RIGHT: #000000 1.5pt solid; PADDING-TOP: 1px">
<DIV align=center><FONT style="FONT-SIZE: 11pt" face=宋体>{DATA_22}</FONT></DIV></TD></TR></TBODY></TABLE></DIV>