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Signatu <br />EH230038 <br />(revised 1/31/02) <br />RETROFIT OR REPAIR <br />1. Site map enclosed YES [ ] NOK <br />2. Spec sheets attached for equipment to be installed YES NO [ ] <br />3. Description of work to be completed: <br />L 4 -GS -k-> > ; I mo; vVi.- 7 ,oma C A-,,� u LA-�,U S 6-t4 Cc :t <br />C 0 -t -CT Al -t4 vvl- <br />4. Description of equipment to be used: <br />E "ivn - 2 o C -r- /, c -r F.-_ S T I T I A- L S F-4 5 0 ►'Z r0 '1- <br />1::-�1B6-41-C,LA-SS Tom( C_ , &0o)32 41�7 :� 1y3`i0 - <br />5. All equipment is State certified or approved. YES[] NO [ ] <br />6. econtamination Procedures: <br />a. Wil g be decontaminated prior to roval? YES [ ] NO[] <br />b. Identify contracto orming ontamination: <br />Name--------- -------Phone(----)------------ <br />Address _"__ -------City -------------Zip --- <br />2 <br />