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0 RETROFIT OR REPAIR 6 <br />1. SITE MAP ENCLOSED WITH EQUIPMENT SHOWN/SPECIFIED. YES X X NO (] <br />2. DESCRIPTION OF WORK TO BE COMPLETED: <br />]2itm= test exi sting rt 1 i ne t -a det-ermi ne ti c1btness of scm- mndmzz <br />line, repair line. Visual inspection shows termination fitting at grade <br />T.j 11 )-�ce <br />Stet Nitrogem test I� rfo=ed <br />If results are a tight line,the termination fitting will be replaced., and <br />and line tested again. <br />ADDITIONAL PAGES MAY BE ATTACHED. <br />3. DESCRIPTION OF EQUIPMENT TO BE USED: <br />4. ALL EQUIPMENT IS STATE CERTIFIED OR APPROVED. YES AX NO [I <br />2 <br />