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Nov. 5. 20041 4:04PM I ' ht Environmental 832-5152 ='4 --In No -5347 P- 2= <br />RETROFIT: R REPAIR <br />1. <br />PI <br />U <br />Site map enclosed YES NO[) <br />Spec sheets attached for equipment to be installed YES� NO E ] <br />LesCPiption of equipment to be used: _ — .A r a /I <br />S. All equipment is State certified or approved • YF -S NO [ ] <br />g, cQnttarninati®n P duress bk <br />a. Will piping be decontaminated prior to removal? <br />b. identify contractor performing decontamination: <br />Address City dip <br />c, Describe method to be used fordecontamination; <br />;d. Describe how rinsate material will be stored onsite prlOr to manifesting offsite' <br />®, Rinsa►te ruler and <br />P,,Mlttee, Trestm®nt, Storage & Disposal FBdlity: <br />Hauler Name <br />-1-19-illt <br />