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1. <br />2. <br />3. <br />C� <br />01i'18/2005 17: 11 <br />2094683e FIFTH FLOOR <br />RETROFIT OR REPAIR <br />Site map enclosed YES V/- NO[] <br />Spec sheets attached for equipment to be installed YES u,}� NO [ <br />PAGE 05 <br />Description of equipment to be used: <br />5. All equipment is State certified or approved. YES [bf NO [I <br />6. Decontamination Procedures: /L /A —,)1"-0/ <br />a. . piping be decontaminated prior to rem al? YES[] NO[] <br />b. Identify tractor performing decontamination: <br />Name Phone_ _) <br />Address City Zip <br />C. Describe method to be used for contamination: <br />d. Describe how rinsate material will be stored on ' e prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Fa <br />Hauler Name - Phone(`_) <br />