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f� 10/25/2002 10:36 20946E 3 FIFTH FLOOR PAGE 02 <br />RETROFIT_OR REPAIR <br />1. Site map enclosed YESX NO [ ] <br />2. Spec sheets attached for equipment to be installed YES [ ] NC* <br />3. Description of work to be completed: <br />4- <br />4. Description of equipment to be used: <br />�c� S S 71 a N S r Y—/ L-) c o ic1 7—c,_;& e t- <br />5. All equipment is State certified or approved. YES , NO { ] <br />6, Decontamination Procedures: <br />a_ Will piping be decontaminated prior to removal? YES [ ] NO� <br />b. Identify contractor performing decontamination: <br />Name L, / r E -TV-- Phone( ao `I) 4- 6 l- 3 3% <br />Address iZ S 3 Wc 7 ey d city S -%kI/ Zip <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 Phone(____� <br />2 <br />R a <br />2e eie c- a <br />x e e N <br />I N Ttr �t ,u S <br />% o ,J C cs Q T-0- f` N <br />1' 9- <br />4- <br />4. Description of equipment to be used: <br />�c� S S 71 a N S r Y—/ L-) c o ic1 7—c,_;& e t- <br />5. All equipment is State certified or approved. YES , NO { ] <br />6, Decontamination Procedures: <br />a_ Will piping be decontaminated prior to removal? YES [ ] NO� <br />b. Identify contractor performing decontamination: <br />Name L, / r E -TV-- Phone( ao `I) 4- 6 l- 3 3% <br />Address iZ S 3 Wc 7 ey d city S -%kI/ Zip <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 Phone(____� <br />2 <br />