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/ Sierra Chemical Co. <br /> L <br /> A Carus Company Work Order Request Form (electronicversion) <br /> Engineering/Safety Review: <br /> Prior To Commencing Work The Following Condition Must Be Met <br /> Safe Work Permit(Confined Space, Lockout/Tagout, Hot Work, and/or Fall Protection): N/A <br /> 0 <br /> Personal Protective Equipment (PPE) Requirements: Standard <br /> Click here to enter text. <br /> Other: Click here to enter text. <br /> Reviewed By: Alex Re non 4/5/2016 <br /> Maintenance/Contractor Work: <br /> Work Performed: <br /> Door knob installed <br /> Parts/Materials Used: <br /> Lock Entry Tvlo US3 VPC ($9.99) from ACE Hardware on Fremont <br /> Work Completed By: Justin Lankford 4/6/2016 <br /> Quality Assurance/Quality Control Review: <br /> Work Completed as Requested, Equipment/Process System Returned to Normal: <br /> yes <br /> Spare/Replacements Parts Correct, Purchase Order and Other Documentation Attached: <br /> Part correct. <br /> Reviewed By: Alex Re non 4/7/2016 <br /> APPROVALS <br /> Facility Ma er Maint___enancg2 Compliance <br /> 1/ moic off" <br /> Revision 7/13/15 Form WOR.16.E <br />