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08/25/2004 12:19 5594853165 BANKS & CO. PAGE 03 <br />Signature�� <br />EH230038 <br />(revised 1/31/02) <br />RETROFIT OR REPAIR <br />1, Site map enclosed YES[] NO K <br />2. Spec sheets attached for equipment to be installed YES NO <br />3. Description of work to be completed: <br />10 Cc, 0,7 Dz-q1z--T4-4j-j <br />4. Description of equipment to be used: <br />Bad 'ObOVY WAxi.-Ld <br />5. All equipment is State certified or approved, YES NO <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? A114 YES[] NO[] <br />b. Identify contractor performing decontamination, <br />Name Phone(_)_ <br />Address City -zip <br />K <br />