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Jim Thorpe , Inc. <br />By <br />Signature ------------ ------------- President__ <br />EH230038 <br />(revised 1/31/02) <br />1. Site map enclosed YES [j NO [ ] <br />2. Spec sheets attached for equipment to be installed YES :K] NO [ ] <br />3. Description of work to be completed: <br />Removal of the existing dispensers, pump islands, product lines, vent <br />lines and vapor recovery`_lines. Removal of the existing tank and <br />annular space monitoring system. Removal of the existing drop tube <br />fill limiters and over §Lill boxes. Replacement with new approved _ <br />equipment all of the preceding and installation of dispenser pans. <br />Reconfiguration of the new pump islands. <br />4. Description of equipment to be used: <br />See attached list. <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 [T NO[] <br />b. Identify contractor performing decontamination: <br />Name Jim Thorpe Oil,_ Inc ________Phone( -209--)-368-6175 <br />Address P.O. Box 357_______________City_Lodi,_CA ___Zip_95241-0357 <br />9 <br />