Mobile Repair Request

UTLX Mobile Repair Services Request

Mobile Repair Services Manager: Bob Drag

Phone Number:
312-431-5009

Fax Number:
312-957-1546


Details
Reporting Mark:	Car Number:
Commodity:
MSDS Available:	Yes	No
Flash Point:

Car Status:	Empty/Cleaned	Empty/Not Cleaned	Loaded	Unknown
Type of Car:	Pressure	Non-Pressure	DOT Class:
Insulated:	Yes	No
Bottom Outlet Valve:
Top Valves:

Description of Work:
Location of Work Area:
Hot Work Permit:	Yes	No	Number:
Hotwork Restricted Area:	Yes	No	Fire Extinguisher:	Yes	No

Car Owner:
Car Lessee:

Car Location
Customer:
Plant:
Address:
City:			State:
Contact:			Phone Number:

Employee Making Request
Name:
Company:
Phone Number:
Fax Number:
Email Address:			Send copy to this email address

Copies To enter multiple email addresses per line separate each with a comma, for example abc@xyz.com,def@cba.com
To this e-mail address:
To UTLX Customer Service Representative at e-mail address: