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84/25/2005 11:04 2094663433 FIFTH FL OM PAGE 03 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO <br /> 2. Spec she allched for equipment to be Installed YES NO <br /> 3. Description of work to be completed: <br /> &gELAc5b qi Lz--AE jPg7-j6;c-rpg= Wi-,74- <br /> VAL0P_LC-SS J-D :YAW <br /> 4. Description of equipment to be used: <br /> 5, All equipment is to certified or approved. YES NO <br /> 6. Decontamination Procedures: Af <br /> a. Will piping be decontaminated prior to removal? YES11 NO [] <br /> b. Identify contractor performing decontamination: <br /> Name �Phone( <br /> Address city —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 PhoneC_____j <br />