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18/2005 09:01 683433 EHD PAGE e3 <br /> RETROFIT OR REPAIR <br /> Site map enclosed YES [J NO <br /> 2. Spec sheets attached for equipment to be installed YES J NO �•j/ <br /> 3. <br /> Description of work torbp completed: <br /> 444 <br /> 4. Descnpdon of equipment to be used: <br /> `5. All equipment is State cert►fled or approved. YES [ NO ( J <br /> 6• Decontamination Procedures: <br /> a. Will piping be deco tannin prior t re oval? <br /> YES [ J NO ( J <br /> b. Identify contractor erform g deco to Ina on: <br /> Name honeL.) <br /> Address City zip <br /> c, Describe method to be used or decontamination: <br /> d. Describe how rinsate material will be stored n nor to manifesting offsite: <br /> e. Rinsate Hauler and permi ed Tre tme t, S ge& Disposal Facility: <br /> Hauler Name <br /> PhoneL , _) <br /> 2 <br />