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MAR-19-03 14:57 FROM:PGBZ SUPP CONCORD 510-674-6565 70:PO9 942 1697 PAGE:003/020 <br /> T <br /> Signat <br /> EH230038 <br /> (revised 1131107) <br /> RETROFIT OR REPAIR <br /> 1 . Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES DI NO [] <br /> 3. Description of work to be completed; <br /> -(Tj, 'F1•kbR LE <br /> Ta PASS SS��t �i g�CC D J���l t aril ►S 1�11i�T T��TLA1 <br /> 4. Description of equipment to be used: <br /> 5 LLeF_�- F:- ZEIAo�>- -VKMX- RE-' CE_QS <br /> TPAs <br /> 5. All equipment is State certified or approved. YES ] NO [] <br /> 6. Decontamination Procedures: tA/,\ <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] N j , <br /> b. Identify contractor performing decontamination_ rtA <br /> Name_-� - ----------------Phone(_--}_--- <br /> Address__---__---- _ --- W City_-,- --- zip_ <br /> 2 <br />