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Oct 15 04 10: 49a (2091 794-0112 p. 2 <br /> ini iai Ltltl4 1b:09 20 433 FIFTH FLOOR • PAGE 04 <br /> RETROFIT OR REPAIR <br /> t• Site map enclosed YES[] NO [0( <br /> 2. Spec sheets attached for equipment to be installed YES [] NOY <br /> 3. Description of work to be completed: <br /> L1 <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YESX NO [] <br /> 6. Decontamination Procedures: r 1 /P <br /> a. Will piping be decontaminated prlorto removal? YES [] NO <br /> b. Identify contractor performing decontamination: <br /> Name Phone( <br /> Address cityp <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment. Storage & Disposal Facility: <br /> Hauler Name l Phone( <br /> 2 <br />