MGFL 23

______________________201
Act
de cercetare a evidenei i folosire a apei reci/calde pe adresa:

str. ______________________________nr. bloc________ ap.________ tel. _____________

Subsemnaii __________________________________________________________________________
n prezena locatarului: ________________________________________________________________
s-a efectuat cercetarea strii tehnice a reelelor su ap rece, ap cald menager, aparatelor de eviden a
consumului i modul de racordare a lor. La momentul controlului s-au depistat urmtoarele:

1. Contor nr. _______________ marca ________________ tip ap__ _______ indicaii curente ________
Indicaii de facto _________ consum nedeclarat _____________ verificare metrologic ____________
Sigila ______________mod de montare ____________________ exist.filtrului/(clap invers) _______
Alte nsemnri _________________________________________________________________________

2.Contor nr. _______________ marca ________________ tip ap _________ indicaii curente_ ________
Indicaii de facto _________ consum nedeclarat _____________ verificare metrologic ____________
Sigila ______________mod de montare ____________________ exist.filtrului/(clap invers) _______
Alte nsemnri _________________________________________________________________________

3.Contor nr. _______________ marca ________________ tip ap _________ indicaii curente ________
Indicaii de facto _________ consum nedeclarat _____________ verificare metrologic ____________
Sigila ______________mod de montare ____________________ exist.filtrului/(clap invers) _______
Alte nsemnri _________________________________________________________________________

4. Contor nr. _______________ marca ________________ tip ap ________ indicaii curente ________
Indicaii de facto _________ consum nedeclarat _____________ verificare metrologic ____________
Sigila ______________mod de montare ____________________ exist.filtrului/(clap invers) _______
Alte nsemnri _________________________________________________________________________

5. Contor nr. _______________ marca ________________ tip ap________ indicaii curente ________
Indicaii de facto _________ consum nedeclarat _____________ verificare metrologic ____________
Sigila ______________mod de montare ____________________ exist.filtrului/(clap invers) _______
Alte nsemnri _________________________________________________________________________
Nr. de locatari cu viz de reedin n apartament ___________ domiciliai (fr viz) _____________
Pentru nlturarea deficienelor se prescrie a efectua urmtoarele: ______________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Semntura _____________________________________________________________________________
Locatar ________________________________________________________________________________