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i r <br /> 06/09/2004 09:15 209468 •..,3 FIFTH FLOOR PAGE 05 <br /> Signature <br /> EH230038 <br /> (revised 1131/02) <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO[] <br /> 2. Spec sheets attached for equipment to be installed Y44 NO[] <br /> 3. Description of work to be completed <br /> 4. Description of equipment to be used= <br /> 5. All equipment is State certified or approved. YES NO[� <br /> g. Decontamination Procedures: <br /> Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor pe decontamination: <br /> Name — <br /> Address City Zip <br /> 2 <br />