If you are a human and are seeing this field, please leave it blank. Facility Name Facility Contact Manufacturer/ Make/ Model Date of Manufacture Service Provider Last Date of X-Ray Tube Replacement Was X-ray Tube Installed New or Refurbished Current mAs or Scan Seconds Type of Console (i.e. Octane, Extreme) Software Level/ Enabled Licenses Licenses on Workstation Trailer Manufacturer/Size Trailer DOM Road Worthy/DOT Certified? Generator Type Available for Removal Date Asking Price
