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FROM : MANTECA LIQUOR AND FOOL• FAX NO. 209 239 4550 .May. 18 2004 12:36PM P2 <br /> Signature__.... _(.�,.4.}i. L I Z' <br /> V <br /> EH230038 <br /> (revised 1131102) <br /> RETROFIT REPAIR <br /> 1. Site map enclosed YES[I NO/ <br /> 2. Spec sheets attached for equipment to be installed YES NO[] <br /> 3. Description of work to be completed: (� <br /> -- -- �epL9Ce, (V1eJ.wNtUad `eA k <br /> oN e:- 5vt3 P-jr&D 62waN) P&4.e QNNUdL fzs T : <br /> Tv SA e_J'j&e VJ A C'2'4' 1Pteo �4-risjjj axm_ �ANv 'Pt ce-Ak <br /> gAed,jLf_ vyr-}k f–gyire oogN+&L, lieto k P&P ? <br /> i F (2yo_,aRz 2 <br /> r- ` <br /> 4. Description of equipment to be used; <br /> 0 ) R-ed F �( I <br /> 5. All equipment is State certified or approved. YES/ NO [] <br /> 6. Decontamination Procedures: AA d <br /> a. Will piping be decontaminated prior to removal? YES[] NO,[]� <br /> b. Identify contractor performing decontamination: f <br /> Name-----------_-----...----Phone( ----- <br /> Address r—_-_� —._--_... —_City------.--Zip <br /> 2 <br />