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Jun 16 04 01:51p Car^ i e Brown [ 20 461-G342 P.1 <br />: <br />RETROFIT®R REPAI � d0314111" <br />1. Site map enclosed YES�`-No- fj- <br />2. Spec sheets attached for equipment to be installed YES <br />Nt)f I <br />3- De:lc:6ptic n of worts to be completed: <br />di C 6 <br />Q "'d e t lR <br />7. <br />a AN off, C7 <br />---�— ^' Xr e..s <br />acrr3p:inn of ani`rir%rnc nt 2n ha s,cnd= <br />., <br />iA? <br />.'- <br />S_ Ail equiprnent is State certibed or approved. YES NO <br />6, Decontaminatiorn Procedures: <br />a. 'Will piping be decontaminated prforto removal? � YES[] '�K? <br />b_ Identify- contractorpet 'jormili q deconiamiriat1011: <br />Name <br />- <br />Address city <br />C- Describe rnethod to be used for decontamination: <br />d- Describe .how- ansate material wiff be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treabmert, Storac e Disposal Facility <br />Hauler Name <br />. Phone( ) <br />