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02/21/2003 15:24 3106799°^4 PETCON TECH INC PAGE 03 <br /> 10/16/2002. 15:48 2054683433 FIFTH FLOOR PAGE 84 <br /> Signature <br /> �H23D038 <br /> (revised 1131/02) <br /> RETROFIT OR REPAIR <br /> I. Site Mali)enclosed YE-ft <br /> 2- SPeC sheets attached for equiPrnent to be instalted YES NO t] <br /> 3. Description of work to be completed <br /> ck <br /> 4. description of equipment to be used: <br /> 5. A equipment Is State certified or approved. Yes E NQ f] <br /> 6, De ntarnination Procedures: <br /> a. Wlll pi be decontaminated prior to removal? <br /> YES [] go[] <br /> b. Identify contra c:to rforming decontamPnertion, <br /> Name <br /> Address <br /> .�'" City <br /> 2 <br />