ESBD_401277_1748872543207_ATF572~1.PDF

ATTACHMENT G.J.1 - ELLINGTON AFB (EF)

MAINTENANCE SUMMARY FORM

FACILITY NO.: LOCATION NO.:

PROJECT: CONTRACT NO.:

1. EQUIPMENT ITEM

2. MANUFACTURER

3. EQUIPMENT/TAG NUMBER(S)

4. PART NO. / SERIAL NO.:

5. WEIGHT OF INDIVIDUAL COMPONENTS (OVER 100 POUNDS)

6. NAMEPLATE DATA (hp, voltage, speed, etc.)

7. MANUFACTURER'S LOCAL REPRESENTATIVE

a. Name____________________________ Telephone No.

b. Address

8. MAINTENANCE REQUIREMENTS

Maintenance Operation

Comments

Frequency

Lubricant

(If Applicable)

List briefly each maintenance operation required and refer to specific information in manufacturer’s standard maintenance manual, if applicable.

(Reference to manufacturer’s catalog or sales literature is not acceptable.)

List required frequency of each maintenance operation.

Refer by symbol to lubricant required.

ELLINGTON FIELD, HOUSTON, TX 21 May 2024

9. LUBRICANT LIST

Reference

Symbol

Shell

Standar d Oil

Gulf

Arco

Or Equal

List symbols used in No. 7.

above.

List equivalent lubricants, as distributed by each manufacturer for the specific use recommended.

10. RECOMMENDED SPARE PARTS FOR GOVERNMENT INVENTORY

Part No. Description Unit Quantity Unit Cost

Note: Identify parts provided by this Contract with two asterisks.