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1'0/25/2002 10:36 209468: FIFTH FLOOR PAGE 02 <br /> RETROFIT_OR REPAIR <br /> 1. Site map enclosed YESX NO [] <br /> 2. Spec sheets attached for equipment to be installed YESK NO [) <br /> 3. Description of work to be completed: <br /> A s s / s 1 r s e S e r_S a ti <br /> � J <br /> (3a C e � j NS erS cc IPS e L 6 <br /> S X P N S -e V_ <br /> 4. Description of equipment to be used: <br /> G ; / 6 ct r c o N c o i^ e SG o 3 1 e ►� c( e s' 3 -t 1 <br /> 5. All equipment is State certified or approved. YES NO [] <br /> ell <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? Aix YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> i <br /> Name Phone( ) <br /> Address city Zip <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment. Storage& Disposal Facility: f <br /> Hauler Name PhoneL____J <br /> 2 <br />