Master_Utility_Outage.pdf

PDF 614 KB Posted

Attached to
Construct Addition to Corrosion Control Facility Bldg 180 Federal contract opportunity
Solicitation number
F3QCCL6062A003
Issued by
Department of the Air Force Materiel Command Lifecycle Management Center Robins Air Force Base

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Master Utility Outage

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Text version

UTILITY OUTAGE REQUEST

DATE:

CHECK OUTAGE TYPE: Electrical Water Steam Chilled Water Other

IF OTHER, EXPLAIN:

FACILITY NUMBER(S):

FACILITY MANAGER SIGNATURE AND ANY REQUIRED USER COORDINATION

LABOR RELATIONS COORD REQUIRED: YES NO

(DATE) AT REQUEST OUTAGE BEGINNING:

SIGNATURE:

ENDING ON: (DATE) AT (TIME)

REASON FOR

OUTAGE:

REQUESTER:

PROJECT NUMBER:

COMPANY:

PHONE NUMBER:

PROJECT/CONTRACT MONITOR NAME:

PHONE NUMBER:

SHOP COORDINATION Facilities Super Infrastructure Super Utilities Super INITIAL AS NEEDED Alarms Industrial Mechanical Utilities

Interior HVAC Fire Dept Exterior Zone 1 Other Power Production

78 CES/CEPC (SERVICE CALL MUST COORDINATE ON ALL OUTAGES AND RECEIVE A COPY OF

SIGNED OUTAGE REQUEST)

OUTAGE IS APPROVED/DISAPPROVED:

This form effective 03/17/2006

(TIME) AND

78 CES/CL

After electronically completing top portion of form, print for coordination initials and approval signature.

UTILITY OUTAGE REQUEST

DATE:

CHECK OUTAGE TYPE:

IF OTHER, EXPLAIN:

FACILITY NUMBER(S):

FACILITY MANAGER SIGNATURE AND ANY REQUIRED USER COORDINATION

LABOR RELATIONS COORD REQUIRED:

YES

NO

(DATE) AT

REQUEST OUTAGE BEGINNING:

SIGNATURE:

ENDING ON:

(DATE) AT

(TIME)

REASON FOR

OUTAGE:

REQUESTER:

PROJECT NUMBER:

COMPANY:

PHONE NUMBER:

PROJECT/CONTRACT MONITOR NAME:

PHONE NUMBER:

SHOP COORDINATION

Facilities Super Infrastructure Super Utilities Super

INITIAL AS NEEDED

Alarms Industrial Mechanical Utilities Interior

HVAC

Fire Dept Exterior Zone 1 Other Power Production

78 CES/CEPC

(SERVICE CALL MUST COORDINATE ON ALL OUTAGES AND RECEIVE A COPY OF

SIGNED OUTAGE REQUEST)

OUTAGE IS APPROVED/DISAPPROVED:

This form effective 03/17/2006

(TIME) AND

78 CES/CL

After electronically completing top portion of form, print for coordination initials and approval signature.

UTILITY OUTAGE REQUEST

Preferred Customer Normal.dot william.fowler Microsoft Office Word

3/10/2006 1:32:00 PM

3/10/2006 1:30:00 PM

3/10/2006 1:32:00 PM

Dell Computer Corporation 28672

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