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Signature <br /> EH230038 <br /> (Revised 1/31/02) <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [] NO [X] <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [X] <br /> 3. Description of work to be completed: <br /> Replaced Failed Mechanical Leak Detector on Regular Unleaded <br /> tank with new Vaporless VMI LD 2000 leak detector, serial <br /> number 03101456, retested and passed. <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES [X] NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name: Phone: ( <br /> Address: City: Zip <br />