Laserfiche WebLink
09/12/2003 15: 01 925516FA98 AMERICAN CONSTR11TION PAGE 02/02 <br /> 09/ 1/2003 13:17 20941 33 FIFTH FLOOR PAGE 02 <br /> lL:10 46401;; ENVIRONMENTAL HEALTH PACE 02 <br /> Signature <br /> EH230038 <br /> (revised 1131102) <br /> RETROFIT OR REPAIR <br /> I- Site map enclosed YES(] No [j <br /> 2. Spec sheets attached for equipment to be installed YES(] NO[] <br /> 3. Description of work to be cam pleted: <br /> 4. Description of equipment to be,u/sed: <br /> h�E'tyYGa�—__�1/ 1'R r��P(DY'C�rr�/Gt,rtul[L✓1.1*_ __ �lf�` <br /> 5. All equipment is State certified or approved. YES�}'� NQ[] <br /> 6.- Decontamination Procedures: 1111A <br /> a. Wil piping be decontaminated prior to removal? YES[] NO[] <br /> b. ldentif contract- -performing decontamination: <br /> Name Phone_) — <br /> Add rens city Zip <br /> 2 <br />