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Origination Date:
Fund Code:
Originator:
Supervisor/RA/RD:
Priority:
EMERGENCY
HIGH-PRIORITY
IMPORTANT
SCHEDULED
FILL-IN
SHUTDOWN, PLANNED OU
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Safety?
No
Yes
Safety?
Asset No:
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Trades:
VEHICLE EQUIPMENT OPERATOR
HVAC
AUTO
MOVING
CARPENTRY
ELECTRICAL
PLUMBER
PAINTER
LOCKSMITH
HOUSEKEEPING
GENERAL
GROUNDS
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Work Location:
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Work Requested:
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