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Jun 16 05 09:33a Carrie Brown (20 461-6342 p.1 <br />I `Ir d, <br />RETROFIT -OR REPAIR I, u <br />11- Site reap enclosed YES [ } NO [ ] <br />2_ Spec sheets attached for equipment to be installed YESH. ]. NO[] <br />3_ Description of work fo be. completed;' <br />4_ Des. n of equipment to be used: ' <br />5_ Ail. eguiprnent is State ceroed or approved. YES [ } Na [ ] <br />6_ Decontamination Procedures:. . <br />a- Will piping be decontaminated prior- to removal? YES [ } NO [ ] <br />b_ Identi corttractdr performing decontamination: - • - ---_ _ _ .. <br />fY <br />Name Phone( <br />Address city Zip <br />C. Describe method to be used for decontamination: <br />d: Describe fi��iv rinsa_e material stored onsite prior to manifesting. offsite_: <br />' I <br />e_ Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />hone( <br />Hauler Name P ) <br />