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i J <br /> 07/23/2003 09:06 2094683433 FIFTH FLOOR PAGE 04 <br /> RETROFIT O REPAIR ) <br /> 1. Site map enclosed YES [] NO [4 <br /> 2. Spec sheets attached for equipment to be installed YES [] NO j <br /> 3. Description of work to be completed: <br /> REPLACE THE PREMIUM LINE LEAK DETECTOR. <br /> 4. Description of equipment to be used: <br /> RED JACKET FX IV MECHANICAL LINE LEAK DETECTOR. <br /> 5. All equipment is State certified or approved. YES [T NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <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: <br /> Hauler Name Phone_} <br /> 2 <br />