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11!+77/2032 11:32 2E94563433 FIFTH FLOOR PAGE 0? <br />RETROF1T,OR RE'PAI'R <br />1. Site map enclosed YES N1 NO [ <br />2. Spec sheets attached for equipment to be installed YES [t/ NO j j <br />3. Description of work to be completed: <br />G„ <br />l'�' l��C� = Uf-IO�f� - U��,,P��Ns�t�•�.. ct��`� t r� rn��4"�" �Ui�c <br />4. Description of equipment to be used: <br />W <br />M <br />All equipment is State certified or approved. YES [ NO[) <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES NO C ) <br />b. Identify contractor {performing decontamination: <br />Name �q5-t-AU7 CONSTRVCtAOI`4 Phona(20') 0 <br />Address 0. city Leo zip' l <br />C. Describe method to be used for decontamination: <br />ALL P(P Nc, Ntu-p-,c= Rtf`1,- tFv w 1►� c3oo-AL. C>R.ti. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />1'� D Pym N t L -t_ �5a- s E --A L.i —0 At -At) <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Neuter Name G =e7( , W. LmW R.`i I G. Phorie(_'20') q;45 - a�j} <br />2 <br />