Attach_11_-_Utility_Outages.pdf
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- Attached to
- Ellsworth Air Force Base- SABER Federal contract opportunity
- Solicitation number
- FA4690-16-R-0007
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Attach 11 - Utility Outages
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G:drive(CECS)
FA4690-16-R-0007 Saber Attachment 11
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) _____
| CEOIU (Utilities) _____ CEOHS (Structures) _____ |
| CEOFE (Electric) _____ CEFT (Fire Dept Tech Svs) ___ |
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