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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NO <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO)4 <br /> 3. Description of work to be completed: <br /> Re-o 1C�C, 1� Mb V otbty ) s�?"V"'P 1 ni- L t S�`� It�C) ' +_" <br /> &r,V.,p,wUor <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 cohtractor 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 />