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11/10/2005 13: 11 4640138 � ENVIRONMENTAL HE* PAGE 03 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES j] NO <br /> 2. Spec sheets attached for equipment to be installed YES [I NO W <br /> 3. Descri tion of work to be completed: <br /> �v nJctf l�1�� �?Q!L..- i�-i e # 3- �, `�'6)eif-' f-Pa"yn /�ct��� <br /> qA L-1 <br /> !AJ r w o r1 r e,,.V 0� �� �+ ! vT� Leas �,�v r� 10e — <br /> f2 ... <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES I) NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phone{ ) <br /> Address`�4 ] VN— —city - Zip <br /> C, Describe method to be used for on amination: <br /> d. Describe haw rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted+Tr atment, Storage & Disposal Facility: <br /> /" f.:. <br /> Hauler Name � Phone(____!) <br />