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STATE OF CALIFORNIA <br /> PLANT OPERATIONS WORM REQUEST(ATTACHMENT A) DEPARTMENT OF CORREUI'IONS AND REHABIU I A I IUN <br /> C� D�isa(02/09) <br /> PLANT OPERATIONS WORK REQUEST <br /> TO: CORRECTIONAL PLANT MANAGER 11,PLANT OPERATIONS DEPT. DATE: I b 3t 4 <br /> BUILDING NUMBER: <br /> r LOCAIION OF WORK: <br /> WORK REQUESTED: M a-VCJ b U,,,, Q WC, <br /> GAS S o <br /> c�, S <br /> REQUESTED BY: DEPT. HEAD/SUPERVISOR AUTHORIZATION <br /> NAME: Zs;� 5 1 S 6--pt-C NAME: ah q l GCi�j <br /> TITLE: L A* I'L&V'' TITLE: ChM 1 (A) <br /> UNIT/DEPT: Ll�-f2, PHONE: ave X67 $° /-DEPARTMENT REQUEST NUMBER: L L 4/ <br /> Work requests involving construction, structural alterations, and/or changes, improvements, or additions to the <br /> existing physical plant, require prior authorization, budgeting, and shall be accompanied by an attached <br /> memorandum stating justification for the requested work. Requests for locks and keys must be submitted via <br /> the Custody Office. Requests for furniture repair are handled by Property Control. <br /> For Plant Operations Use Only <br /> APPROVAL TO PROCEED: DATE: PRIORITY: <br /> IF MORE THAN ONE SHOP INVOLVED, <br /> SHOP ASSIGNED: I�J CHECK HERE. <br /> COMPLETED BY: COMPLETION DATE: <br /> #OF HOU RS: LABOR COST: MATERIALS COST: <br /> TOTT COST': <br /> #OF 1/M: #OF HRS. PER I/M: <br /> COMMENTS: N0V 13 2014 <br /> ENVIRONMENTAL. HEALTH <br /> EXHIBIT 5 DEPHRTIiEi1T <br /> OP-FMD-0100 PLANT OPERATIONS LOG# <br />