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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 ❑ <br />3. Description of work to be completed: <br />Furnish necessary material & labor to replace 91 octane fill bucket. <br />4. Description of equipment to be used: <br />Pomeco 511 EVRDV <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 ❑ n/a <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 bVtored onsite prior to manifesting offsite: <br />e <br />Rinsate Hauler and per <br />Hauler Name: / <br />Hauler Regist tion # _ <br />Address• <br />Permitted Disposal Site: <br />Treatment, Storage & Disposal Facility: <br />Phone: ( <br />City: <br />7. 6. Describe the method that will be utilized to purge and/or inert the piping: <br />EH 23 046 (revised 1/24/02) <br />c\sale\f\p\repairs3-eh23046.wpd Page 1 WO #124679 <br />Zip: <br />