Atch_1_Utility_Outages.doc
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- FA4690-15-R-0005
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Atch 1 Utility Outages
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Attachment 1
UTILITIES OUTAGE APPLICATION AND APPROVAL FORM
Contract/Project Number: ______________________________________________________
Project Title: _________________________________________________________________
Type of Outage:
_____WATER _____ELECTRICAL _____NATURAL GAS _____COMMUNICATIONS
_____OTHER (Specify) _________________________________________________________
Purpose of Outage: ____________________________________________________________
Location of Outage: ___________________________________________________________
Requested Date: _______________________ Time: ___________ thru ____________ Hours
Shop Assistance Required? (Yes/No) (Specify) _____________________________________
Submitted By: _______________________ _______________________ ________________
(Name)
(Organization)
(Date) xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
FACILITY AFFECTED
Date Person
Phone
Using
Nomenclature/Bldg # Contracted Contacted Number Agency
Coordinator: ______________________________________ Phone No. _________________
CEOIU (Utilities) _____
CEOHS (Structures) _____ CEOFE (Electric) _____ CEFT (Fire Dept Tech Svs) ___
CEOIH (HVAC/R)_____ CEOIHC (CASS) _____
CEOSC (Cust Service) _____ CEOD (CE Ops Deputy) _____
CEOFP (Power Pro) _____ CEPM (Const Mgmt) _____ G:drive(CECS)
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