DA Form 5987-e Blank Fillable

Annex A to Lesson Plan DATE: 15-JUN-94

DK02 MOTOR EQUIPMENT DISPATCH HHT 5-15TH CAV 1ATB BUILDING #2789 FORT KNOX, KY 40121 PHONE NUMBER: (502) 624-7418

DA FORM 5987-E UIC: W1L4ZB

DATE DISPATCHED: 15-JUN-94 TIME DISPATCHED: 0804 -------------------------------------------------- EQUIPMENT DATA --------------------------------------------------ADMIN NUM: SERIAL NUM: EQUIP MODEL: REGISTRATION NUM: EQUIP NOUN: EQUIP LICENSE NUM: EQUIP NSN: KEY NUM: ------------------------------------------------- SERVICE DUE DATA -------------------------------------------------TYPE DATE MI/KM/HR TYPE PMCS DUE: NEXT OIL ANALYSIS DUE: NEXT LUBRICATION DUE: NEXT SPECIAL SERVICE DUE: ---------------------------------------------- DISPATCH INFORMATION --------------------------------------------OFFICIAL USER NAME/PHONE NUM: DESTINATION: EXPECTED DATE/TIME OF RETURN: EQUIP DISPATCHER'S SIGNATURE: _________________________ 1ST OPERATOR'S SIGNATURE: _________________________ 2ND OPERATOR'S SIGNATURE: _________________________ OFF POST AUTHORIZATION: _________________________ DISPATCH OUT REMARKS: --------------------------------------------- END ITEM USAGE DATA -----------------------------------------------EQUIPMENT NOUN

M/H/K

CURRENT READING

READING AT RETURN

FUEL USAGE (IN GALLONS)

____________

_____________

------------------------------------------ COMPONENT(S) USAGE DATA ------------------------------------------COMPONENT SERIAL NUMBER NOUN

6L1MAR99DK02

M/H/K

CURRENT READING

A-5

READING AT RETURN

OIL ADDED (IN GALLONS)

VIEWGRAPH #4