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Feb 10 05 09: 53a Carrie Brown (209) 461 -6342 p. 1 <br /> 01/20/2005 15:50 209466" , FIFT FLOOR ? PAGE 03 <br /> RROFIT_'OR REPAR <br /> 1. Site map enclosed YES[] NO(] <br /> ?- Spec shE:ets attached for equipment to be installed YES f j. NO[] <br /> I_ Description of work to be.completed: <br /> DWI/ <br /> _ Description of equipment to be used: <br /> All equipinerat is State cefti!W or approved- YES(] <br /> Decontamination Procedures: <br /> a_ Win piping be decontaminated prior to removal? YES j} NO f] <br /> __. b. Iden*-confitxctbrperforming deconta,.inatiort:. ._ - __-_-•-.- . _ _ <br /> Name Phone( )' <br /> Address city Zip <br /> G Describe method to be-used for decontamination: <br /> d_ Describe hdW rinsate materialvrill'•be stored onsite.prior to manifesting.offsite; <br /> e. Rinsate Hauler and permAted Treatment.Storage&Disposal Facility_ <br /> Hauler tVarne� ^----------—... —_Phone(_ <br /> 2 <br />