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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NOV <br /> 2. Spec sheets attached for equipment to be installed YES-0 NO [ ] <br /> 3. Description of work to be cpompleted: <br /> 4. Description of equipment to be used: <br /> &Jzk& :xa S"t--1- <br /> 5. All equipment is State certified or approved. YES p( 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 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 />