A.02.12 Attachment J - Sample Work Request Submission Form_Amend 0002.pdf

NAVY/AIR FORCE CAPITALIZED FACILITIES

MINOR WORK REQUEST (MWR)

PETROLEUM MAINTENANCE CONTRACT W912GB-XX-X-XXXX

ADMINISTED BY THE U.S. ARMY CORPS OF ENGINEERS, EUROPE DISTRICT

Please note: If an emergency exists that threatens health and/or the environment, you must respond in the manner addressed under your local Emergency Response Plan.

Today’s Date: Your Name:

Installation Fuel Facility Requiring Minor Service:

Your Commercial Phone Number: Your DSN Phone Number:

Your Handy Phone Number:

Minor Repair Located at Building #: Date & Time of Discovery:

Name and Phone Number of Person who Discovered the Repair:

Date and Time Call Was Placed to USACE: Who Did You Notify (Name):

Date and Time Responsible Official (RO) Was Notified:

Please provide SPECIFIC details about the repair situation (e.g. provide a description of the problem encountered, building #, type of fuel system (MOGAS, JP, Dispenser #, Tank #, Oil/Water Separator, etc):

Provide a copy of the alarm print out and/or write in the space below the EXACT wording shown on the display screen:

(Please note: All Fuel Master and ATG problems or issues are under the DES-DE funded program and the U.S. Navy Space and Naval Warfare (SPAWAR) is the contract manager. Please contact Mr. Joe Carnes at DSN 421-2634.)

Please Provide the Name and Number of the RO That the Contractor Shall Contact Upon Arrival on Site (RO must ensure access for the contractor to all facilities that require repair service): Contractually Only the RO or His/Her Designated Alternate is Authorized to Escort the Contractor and Sign for Services Rendered:

APPENDIX B - SERVICE ORDER FORM

NAVY/AIR FORCE CAPITALIZED FACILITIES

EMERGENCY WORK REQUEST (EWR)

PETROLEUM MAINTENANCE CONTRACT W912GB-XX-X-XXXX

ADMINISTED BY THE U.S. ARMY CORPS OF ENGINEERS, EUROPE DISTRICT

Please note: If an emergency exists that threatens health and/or the environment, you must respond in the manner addressed under your local Emergency Response Plan.

Today’s Date: Your Name:

Installation Fuel Facility Requiring Emergency Service:

Your Commercial Phone Number: Your DSN Phone Number:

Your Handy Phone Number:

Emergency Located at Building #: Date & Time of Discovery:

Name and Phone Number of Person Discovering the Emergency:

Date and Time Call Was Placed to USACE: Who Did You Notify (Name):

Date and Time Responsible Official (RO) Was Notified:

Please provide SPECIFIC details about the emergency situation (e.g. provide a description of the problem encountered, building #, type of fuel system (MOGAS, JP, Dispenser #, Tank #, Oil/Water Separator, etc):

Provide a copy of the alarm print out and/or write in the space below the EXACT wording shown on the display screen:

(Please note:

All Fuel Master and ATG problems or issues are under the DES-DE funded program and the U.S. Navy Space and Naval Warfare (SPAWAR) is the contract manager. Please contact Mr. Joe Carnes at DSN 421-2634.)

Please Provide the Name and Number of the RO That the Contractor Shall Contact Upon Arrival on Site (RO must ensure access for the contractor to all facilities that require emergency service): Contractually Only the RO or His/Her

Designated Alternate is Authorized to Escort the Contractor and Sign for Services Rendered: