Clinic Facilities form - Jage 3 momm-rsame 120 volts, 60 32 AC sower available Other type AC alactrical power (give voltage Battery powered DC available (give voltage batteries ara racharzged) Has its own generator in good working condition Clinic has {rs own generacor but not in good working condition Community supoliad sewer which is reliable Clinic supplied sower which is unreliable Other (please describe) None available AC eleccric operacad \ = Karos etrizeratiia . ene rerrigerarqon Dimensions of storage space in inches: . - Heigac (please describe) 16. Total mumber of beds in clinic. 17. Number of mattresses. 18. Number of mattresses in good condition. 19. Number of mattresses in poor condition. 20. frequency ) and (state how Trpe of refrigeration: Trees 1S. None available If there is AC power available, describe the source: maaan es i+. bet ed beet Type of alectrical power available for operating equipment: a ee eee 13. Examination table facilities: { ] None ( ] Regular examination cable(s) ( ] Plain cable wich blanket (describe each on the next page) Wideh Depth

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