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10/25/2002 10:36 209468 FIFTH FLOOR • PAGE 02 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES N NO [J <br /> 3. Description of work to be completed: <br /> S « C u.`I- 0—N A 6 r e a 4 , a -A T— c o N c --e- <br /> e-VV0-12 <br /> 0--h o A .v -e S 2-e- 'r Y le-a-14 _ <br /> 4. Description of equipment to be used: <br /> A he t r rJ x /- e e�c� w s Ale- Il s <br /> 5. All equipment is State certified or approved. YES If NO j J <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES NO [] <br /> b. Identify contractor performing decontamination: <br /> Name L A / T% Phone 2dq I - G 3 3 <br /> Address 9 city Zip 9S�Or <br /> C. Describe method to be used for deoontamination: <br /> A {- N I N S <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> s-S�a ISL .,-- � -�„I�L µ -� , <br /> e. Rinsate Hauler and permitted Treatment. Storage& Disposal Facility: <br /> Hauler Name Phone( <br /> 2 <br />