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Dallas County EMS
Truck and Station Repair Request
Date
Employee Name
First Name
Last Name
Station
Choose One
Adel
Perry
N/A
Truck
Choose One
25-91
25-92
25-93
25-94
N/A
Description of Repair Issue
Have You Made Any Attempt to Fix the Issue?
Yes
No
Please Describe Your Efforts to Fix the Issue
disregard this