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11/03/2005_ 13:48 464013 ENVIRONMENTAL TH <br />RETROFIT OR REPAIR, <br />1. Site map enclosed YES [ J NO <br />2. Spec sheets attached for equipment to be installed YES[] NO [ <br />3. Description of work to be completed: <br />JC A�czs �� ► -T-C> V,)`� <br />PAGE 02 <br />4. Description of equipment to be used: <br />Ek \?, C':C��s P" k <br />5. All equipment is State certified or approved. YES j NO [ ] <br />6. Decontamination :. <br />a. Will piping be decontaminated prior to removal? <br />• Identify contractorperforming •- • • <br />j Name Phone <br />Address <br />City <br />�A, YES[] NO[] <br />• <br />t c. Describe method to be used for decontaminatio . <br />d. Describe how rinsate material a Stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler permitted Treatment, Storage & Disposal Facility: <br />Hauler Na Phone(____i <br />