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DEC-31-02 02 :57 PM JAr'KCOFFELT 2094773113 P. 01 <br /> cu,�o lgy4 <br /> J3 FIFTH Fl,, I f'AGt: tf7 " <br /> yR REPAIR <br /> ,•, t�� <br /> RETROFITOR <br /> Site map enclosed YES NO [] f ►` e v, c CA s ��• �`�}. 4 , ' <br /> Spec sheets attach <br /> S: v SPE ed for equipment to be installed YES Np �) <br /> 3. Description of work to be completed: <br /> 7 a.a ,, <br /> 4L 5 <br /> P `( <br /> Y C E' CL Y� ?+v� <br /> :r; <br /> ��ifx 1 �' �/_ ,may) .`".'.'/�:�':.•.. <br /> . 4. Description of equipment to be used/. <br /> �i � J 1_C �' ( _ 7-4 -s — c, 77 7 6 'Z1 ! / C ✓� :�i ya g <br /> u ct .. N� P u -p _ r-x) <br /> " <br /> r3` ^+4: cx. S c+L_ y� 'l.c c►�' r' GL <br /> 77& S'i, agjy{'•yV`'kit <br /> .' S. All equipment is State certified or approved, YES NO [] <br /> 6, Decontamination Procedures:At <br /> Will piping be decontaminated p YES N <br /> a- Co nor to removal? [) <br /> b. Identify contractor performing decontamination- <br /> Name T� _ C.0,V 1 a Phone( ;%0 n? ) 4 G / - 63 37 <br /> Address 3 a �� u ! %'tt'►�^_•���City 5 -x Zi O <br /> c. Describe method to be used for deoontamination: <br /> ,< d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> �7 2.�.r,. _• c( Ge X77 <br /> e. Rinsate Hauler and permitted Treatment, Storage& Disposal Facility; <br /> Hauler Name_ Phone( 5'0 ,4�4.Sr' <br /> ::•,,' a 1 <br /> ��•, .,.1St;."'.4,�. <br />