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11/30/2004 _11:53 20946834 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 />4 <br />5. <br />M <br />Description of equipment to be used: <br />All equipment is State certified or approved. YES NO [ ] <br />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 drisate 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 />