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Be completed by the manufacturer and submitted to DSCC-VQH with the test report) I certify that our quality assurance has verified that all tests described in the report were performed as specified and in accordance with the requirements of the military specifications and standards. I certify that this lot was manufactured to the DSCC-VQH approved baseline at the location indicated above. Manufacturer Representative Name (print or type): Signature: Title: Date: Subgroup failures (list all fa.

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