Laserfiche WebLink
Signature_----- - �-------- <br /> ------- • <br /> EH230038 <br /> (revised 1/31/02) <br /> RETROFIT OR REPAIR <br /> , <br /> 1. Site map enclosed YES [] NO [4 <br /> 2. Spec sheets attached for equipment to be installed YES [ NO [] <br /> 3. Description of work to be completed: <br /> K s ray f.c.AeT,0 o F <br /> • 0 P V PN A-S e,- V12 s 1 a w1 <br /> O AF— W rt(,L YKP5 <br /> 4. Description of equipment to be used: <br /> • O P VJ PiA A-SE, S Ey 2. E Qy IP w-K-`- <br /> • (A/ E t T P,a 4 L P+f <br /> 5. All equipment is State certified or approved. YES NO [] <br /> 6. econtamination Procedures: <br /> a. Wil i i be decontaminated prior to r oval? YES [] NO [] <br /> b. Identify contracto orming ontamination: <br /> -------- -----Phone ---- <br /> Name_________ �------)-------------- <br /> Address ------------------------- City--------------Zip-------- <br /> 2 <br />