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Nov 05 03 02:59p Ca ie Brown [20 ' <br />M. 461-6342 p.l <br />RETROMOR REPAIR <br />3 . Site reap enclosed YES [] NO [I <br />2 Spec sheets attached for equipment to be installed YES t ] NO t j <br />3. Descnpt�on of work to be completed: <br />—41.-1— <br />. bk-j' <br />fajecr�rip tion ()f pn:+iDMent to be1-1 S- <br />0 <br />4. <br />All equipment is State certified or approved. YES [ ] NO t ] <br />6_ Decontamination Proce� •:.ucs: <br />a. Will piping be deconialrzin� YES[] ;ed prior to removal? NO[] <br />b. Identify contractor persorning decontamination: <br />Name <br />Phone(_ ) ---- --- <br />city Zip - <br />Address <br />c, Describe method to be used for decontamination: <br />lt be stored onsite prior to manifesting offsite: <br />d, Describe how rinsate material wi <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name PhoneL �� <br />2 <br />