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�10/25/2002 10:36 209468 Z FIFTH FLOOR PAGE 02 <br />RETROFIT_OR REPAIR <br />1. Site map enclosed YE'% <br />S'NO f ] <br />2. Spec sheets attached for equipment to be installed YESX NO[] <br />3. Description of work to be completed: <br />C- V N,i L'' e re cn -e } -- %W d T' C t. e- 7 N k- S <br />Z c` N e LV r h v- 9 %i S S^ CL 77 t S <br />Cx- N c� r 6 z y ¢ S S N �< o CL <br />6 e rel e- o AJ <br />4. Description of equipment to be used: <br />wo�z� 1iZe r '�A c- Jss s s <br />5. All equipment Is State certified or approved. YES, NO[] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? All YES[] NO(] <br />b. Identify contractor performing decontamination: j <br />Name Phone( ) <br />Address city Zip <br />C. Describe method to be used for decontamination: VIA <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 PhoneL_____) <br />2 <br />