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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NOW <br /> 2. Spec sheets attached for equipment to be installed YES [ NO [ ] <br /> 3. Description of work to be completed: <br /> a-4P X2 tack, &ems W i 4"k. +O►LikIf lectin. <br /> 4. Description of equipment to be used: <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 Ci Zip <br /> C. Describe method to be used forrdecontami tion: <br /> d. Describe how rinsate material wi a sto onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(_) <br /> 2 <br />