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12/18/2003 14: 24 4640136 ENVIRONMENTAL HEALTH PAGE 02 <br /> RETROFIT,OR REPAIR <br /> 1. Site map enclosed YES [] NO �f <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NCM <br /> 3. Description of work to be completed: .G <br /> y /� e r <br /> q Lea,}�Prs ,7 <br /> 4. Description of equipment to be used: <br /> -2l3 `cjaAm <br /> 5. All equipment is State certified or approved. YES ' NO [) <br /> g. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? NO <br /> YES - � <br /> b. Identify contractor performing decontamination: <br /> Phonef ) <br /> Address <br /> city /rte _zip <br /> c. Describe method to be used for decontamination: <br /> :::21r,`n2i'L <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 N e <br /> 2 <br />