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05/06/2002 09:52 4640138 ENVIRONMENTAL HEALTH PAGE 02 <br /> RETROFIT. <br /> -OR REPAIR <br /> 11 site map enclosed YES NO <br /> 2. Spec sheets attached for equipment to be installed YES YJ NO [] <br /> 3. Description of work to be completed: <br /> A <br /> kc, C1 Lci e <br /> s . <br /> 4. Description of equipment to be used: <br /> 3, <br /> ------------- <br /> (10 <br /> 5, All equipment is State certified or approved. YES NO <br /> 6, Decontamination Procedures: YES NO <br /> a. Will piping be decontaminated prior to removal? <br /> b. Identify contractor performing decontamination: <br /> Phone( <br /> Nam <br /> Address <br /> c. Describe mqthod 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-- Phone6— <br /> 2 <br />