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FIFTH FLOOR <br />RETROFIT OR REPAIR <br />1. Site map enclosed YES. NO [I <br />Z. SPec sheets attached for equipment to be installed <br />3. Description of work to be complet d: <br />YES [] NO <br />'C- R h - <br />Z rl i1 <br />4. Description of Equipment to be used: <br />Qt2 __ iii �n�� Lama/ n_n _� C- J/. <br />Pili equipment is State certified or approved, YES <br />Not 1 <br />6. Decontamiriatiurl Procedures: <br />PACE 03 <br />a• M8 piping be decontaminated prior to removal? <br />YES[) NCa [ i <br />b. Identify oontractor performing decontamination: <br />Name_------._._-----------;�honei--- � <br />Address City Zip <br />c• Describe r-nethod to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Mauler and permitted Treatment, Storage & Disposal Facility: <br />f-'auler Name ` <br />