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03/07/2005 16:17 2094683433 <br />1. Site map enclosed YES'�(j <br />FIFTH FLOOR <br />RETROFIT OR REPAIR • <br />RETR <br />NO [I <br />2. Spec sheets attached for equipment to be installed YES fA NO[] <br />3. Description of work to be completed: <br />4. Description of equipment to be Used: <br />PAGE 03 <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 I J <br />b. Identity contractor performing decontarrnination: <br />Name. Phone} <br />Address ' i 1(, Qesk �'tt .��+�3,:� City "i" rl oaTip 4Q S 's go <br />C. Describe method to be used for decontamination_ <br />d, Describe how rinsate material vAll be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permi#ed Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( <br />2 <br />