Exhibit 12 - $500 Request.pdf

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Attached to
Operation and Maintenance of Water and Wastewater Systems Umpqua National Forest (Various Locations)
Solicitation number
AG-04T0-S-17-0017
Issued by

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Exhibit 12

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Approved Denied Notes:

Approved Denied Notes:

Request for Equipment Repair or Replacement to Exceed $500 Request

COR Approval

Requested By:

Item:

Which Plant?:

Date:

Cost:

COR Signature:

Date:

Briefly Describe the Need for this Item:

COR Approval

COR Signature:

Date:

Briefly Describe the Need for this Item:

Request for Equipment Repair or Replacement

Requested By: Date:

to Exceed $500 Request

Cost:Which Plant?:

Item:

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