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� RETROFIT OR REPAIR — <br />1. Site map enclosed YES [ ] NO t' <br />2. Spec sheets attached for equipment to be installed YES j NO [ ] <br />3. Description of work to be completed: <br />r� 1 n e p. td42 _ 3n� Seu-si6V 44 A <br />4. Description of equipment to be used: <br />VR- o O% st"Of <br />5. All equipment is State certified or approved. YES j NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES[] NO[] <br />b. tdentify.contractor peiforming decointammation, <br />'' <br />Address city <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 />