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,s%18/2005 09:01 20933 EHD PAGE 03 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES I J NO [.}� <br /> 2. Spec sheets attached for equipment to be installed YES ( j NO <br /> 3. Descdation of work to be completed: <br /> R�Hv,� Ac�— $ r9 E= e a cA2w� <br /> A 8rvtptf, J.{ Ui r.iJ &4,k1,) ," -r- R>✓crtoy Jh spa e� <br /> r56aJS�42 <br /> 4. Description of equipment to be us d: <br /> 5. All equipment is State certified or approved. YES [-�' NO I J <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [ ) <br /> b. Identify contractor perform4decontamNamee( <br /> Address zip <br /> C. Describe method to be used for deco t ination: <br /> d. Describe how rinsate material will be to d onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted T atment, Storage & Disposal Facility: <br /> Hauler Name Phone( ) \ <br /> 2 <br />