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d/18/2005 09:01 ' 209 83433 EHD PAGE 03 <br />RETROFIT OR REPAIR <br />1.. Site map enclosed YES (j No 1411-� <br />Spec sheets attached for equipment to be installed YES W--� NO <br />3. Description Of work to be cam ted: <br />V <br />4. Description of equipment to be used: <br />5. All equipment is State certified or approved. YES <br />NO <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES( ) NO <br />b. Identify contractor perfor ing decontamination: <br />Name— Phone(—) <br />Address city <br />Zip <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate to i IZ-11 Tbe stored onsite prior to manifesting offsite: <br />itte Tr atme— <br />e. Rinsate Hauler and per itte Trdatmtnt, Ztorage& ' <br />Disposal �Facility; <br />Hauler Name PhoneL_. j <br />O� <br />