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Sign <br />EH230038 <br />(revised 1/31/02) <br />1 ` • <br />RETROFIT OR REPAIR <br />1. Site map enclosed YES [I NOI] <br />2. Spec sheets attached for equipment to be installed YES [ ] NO <br />3. Description of work to be completed: _ <br />\�3j2cv'N e_r j Pu—(2S � .1 os6, i 1 ('Z) <br />'SiLe Str % 00",12 (0V14(\.Y., c i -i PC7t1� <br />�'-� �-►-'` tt,t`7f�rt,��r��-Z. (J�n2. /���:ivi�...-� %�v'l�ti� YIIMt'��S hvv+S <br />+<S `JS - 1 vis l �2� Ey z f j buc ke s <br />cl) gy �_ yc ror- �oOc-<4 . Tyl5 ", Ik Cz 1 PL-" �-v-e S yt cr" {'(( Gkro� <br />4. Description of equipment to be used: <br />Z) Ui e G113 2c ✓tS e,- %�u� Cc�✓�.� 4 �� v�E.i �Cn ✓LS CZ) 'C V Q_i t 1 b�ic� <br />�) v 2 V,`12W 6, c. k.e4 F C2) IP s, AA_ s h11 CA rc p _+U b � , PV Y.e <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[ NO[] <br />b. Identify contractor performing decontamination: <br />Name_ CA — �� C-------------Phone(__)O1--� 6--��-��-t�------- <br />Address ���r�b�r�v, -Q°` ----City �'\� -----Zip %a l <br />2 <br />