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12/02/2002 15:17 2094663433 FIFTH FLOOR PAGE 05 <br /> A ► <br /> Signature___ <br /> eith A. a <br /> EH230038 <br /> (revised 1/31/02) <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES pg NO[] <br /> 2. Spec sheets attached for equipment to be Installed YES NO [] <br /> 3. Description of work to be completed: <br /> Install Beaudreax sensors <br /> and controllers in under dispenser containment pans to <br /> Positively shut off turbines in the event of liquid accumulation <br /> in the dispenser pans. <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES[}] NO[) <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NOK <br /> b. Identify contractor performing decontamination. <br /> ------ <br /> Address---------- ----- ---- City------------Zip------ <br /> 2 <br />