NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
EQUIPMENT UNIT
SHOP EQUIPMENT REPLACEMENT REQUEST
DIVISION:
Division 1
Division 2
Division 3
Division 4
Division 5
Division 6
Division 7
Division 8
Division 9
Division 10
Division 11
Division 12
Division 13
Division 14
Division 15
DATE:
REQUEST NO:
ASSET NO:
YEAR & MODEL:
DESCRIPTION:
REASON FOR REQUEST:
New
Replacement
Other
(If you choose Other, please fill out the following field)
OVERALL CONDITION:
Good
Fair
Poor
Other
(If you choose Other, please fill out the following field)
ESTIMATED COST TO REPAIR:
ASSIGNMENT LOCATION:
REQUESTED EQUIPMENT MAKE:
MODEL:
ADDITIONAL COMMENTS:
signed:
Division Equipment Superintendent
USE THIS FORM TO REQUEST ADDITIONAL AND/OR REPLACEMENT
EQUIPMENT CHARGED TO ADMINISTRATIVE BUDGET OBJECTIVE
CODES -- 513, 515 & 516
signed:
Equipment Plant and Maintenance Manager
Rev. 08/02