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05/24/200E 08:39 2094683 EHD • PAGE 04 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES[] NO� <br /> Z Specsheets attached.for equipment to be installed YES.[] NOS{ <br /> 3. Description of work to.be completed: <br /> 2 - 12�t�T /U/�n /rSGY2li1Y� <br /> 4. Description of equipment to be used: <br /> �1r//6 // C -?3a 4 <br /> 5.. All,equipment is.State certified or,approved. YES j ] NO [ ] <br /> 6. D(:contamination Procedures: <br /> a. Will piping be decontaminated prior to.removal?. YES[]. .NO[] <br /> b. Identify contractor.performing decontamination- <br /> Name <br /> Name Phone(_, <br /> Address city. Zip. <br /> c. Describe.method to be s .for decontamination: <br /> d, Describe.how ' sate.material will be stored onsite.prior to manifesting offsite: <br /> e sate Hauler and permitted.Treatment,Storage & Disposal Facility: <br /> Hauler Name Phone(_} <br /> a <br />