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10l29f2003 14:45 2094533433 FIFTH FLOOR. PAGE C13 <br />RETROFIT OR REPAIR <br />1. Site map enclosed YES [ I NO X <br />2. Spec sheets attached for equipment to be installed YES[] NOX <br />3. Description of work to be completed: <br />rrouu S" <br />4. Description of equipment to be used: <br />C <br />5. All equipment is State certified or approved. YESNO [ ) <br />6. Decontamination Procedures: — ILIM <br />a. Will piping be decontaminated prior to removal? YFS [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone ) <br />Address Q Zip --- <br />C. Describe method to be used for decors rrA'tion: <br />d. Describe how rinsate material Il be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler d permitted Treatment, Storage & Disposal Facility: <br />Hauler Name PhoneL,---)- <br />2 <br />