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11/30/2004 _11:53 2094683433 FIFTH FLOOR PAGE 05 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [] NO [ _ <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed: <br /> t!�9 fit' Sc-c'G•sv:,A/'" i�l PI-C 1 ll** f.'tr i= ii�t/- <br /> //-/Z <br /> 4. Description of equipment to be used: <br /> fJ �u� <br /> 5. All equipment is State certified or approved. YES ( 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 />