1. For 12 Month Period (From - Thru)
Instructions
Purchase Request for Coal, Coke or
Prepare separate request for each kind of Coal
Briquettes
2. Program Number
(See reverse)
3. Thru
4. From (Department, Agency or Installation)
5. To (Chief of Service)
6. Consign To
7. Purchase Request Number
8. Date
9. Kind (Anthracite, bituminous, sub-
10. Tons in Storage
11. Storage Capacity
14. Size (In Inches)
bituminous,lignite, or coke.)
a. Top
b. Bottom
(2) Minimum
(2) Minimum
(1) Maximum
(1) Maximum
12. Tons Due on Existing
13. Actual Consumption
Contracts
(Last 12 Months)
►
◄
17.
Tentative Ship Schedule
15. Analytical Specifications Required
Do Not Write In These Columns
a.
Month & Year
b. Estimated Tons
16.
Approved Analytical Specifications
c. Dust Suppressant
c. Dust Suppressant
Jan 20
a. Min
b. Max
a. Min
b. Max
(Check if applicable)
(Check if applicable)
Feb 20
(1) Moisture
(1) Moisture
Mar 20
(2) Vol
(2) Vol
D
D
R
R
d. Freeze Conditioning
d. Freeze Conditioning
Apr 20
Y
(3) Ash
Y
(3) Ash
(Check if applicable)
(Check if applicable)
May 20
C
C
(4) Sul
(4) Sul
O
O
A
A
Jun 20
(5) Btu
(5) Btu
L
L
e. Approved
Jul 20
(6) AST °F
(6) AST °F
Tonnage
Aug 20
(7) Hardgrove Grindability
(7) H. Grind
Sep 20
(8) FSI
(8) FSI
Oct 20
a.
Maximum % Retained On
b.
Maximum % Passing THRU
18. Screen Size (Round Hole)
Nov 20
(1) Top
Dec 20
(2) Bottom
20. Delivering Railroad
21. Total Purchase Request (Tons)
a. Rail
19. Preferred Method of Delivery (Check One)
0
b. Truck
c. Rail or Truck
d.Barge
22. Railhead for Carload Shipments
23a. Alternate Method of Delivery
23b. Estimated Additional Cost
24. Type of Railroad Cars Required
25. Estimated Charges for Labor and Equipment if Commercial Service is Required for Unloading, Hauling and Storage of Coal
26. State or Local Regulatory Sulfur Dioxide Emission Limits (Show Units)
27. Spur Track To Installation (Check One)
a. Yes
b. No
28. Remarks
29. Technical Point of Contact at Requesting Activity
a. Typed Name (Last, First, Middle Initial)
b. E-mail Address
c. Telephone No.
30. Prepared By
a. Typed Name (Last, First, Middle Initial)
b. Signature
c. E-mail Address
d. Telephone No.
31. Approved at Requesting Activity By
a. Typed Name (Last, First, Middle Initial)
b. Signature
c. E-mail Address
d. Telephone No.
32. Approved By
a. Typed Name (Last, First, Middle Initial)
b. Signature
c. E-mail Address
d. Telephone No.
DD FORM 416, DEC 2008
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