State of California—Health and Human Services Agency California Department of Public Health

Facilities Management Section

WORK ORDER

Section/Unit Section control number Work order number (assigned by FMS)

FMS            
Location Property number Date submitted Date required
           
Item Location of equipment Contact person Telephone number
           
Requested by (Unit Chief) Telephone number FMS authorization signature
JAMES ALEXANDER 510-385-8208
Description of work
     
     
     
     
     
PLANT OPERATIONS USE ONLY
Assigned to Priority number Completion date
Administration
Maintenance Shop
Paint Shop
Electrical Shop
Engineer Shop
 
Comments
     
     
     
     
     
Labor—Employee Number Total Hours Rate/Hour Cost

$ $

$ $

$ $

$ $

$ $
Quantity/
Item Number Material Description Unit Price Cost

$ $

$ $

$ $

$ $

$ $

$ $

CDPH 2227 (9/18)