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RETROF,IT OR REPAIRIql0j <br />1. Site map enclosed YES [ ] NO [ <br />2. Spec sheets attached for equipment to be installed <br />3. Description of work to be com Ickted: <br />VIA <br />4. Description of equipment to be used: <br />YES NO [ ] <br />All equipment is State certified or approved. YES NO [ ] <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor pe rming decontamination: <br />Name Phone(_) <br />Address City <br />C. Describe method to be used for decontamination: <br />YES [ ] NO <br />M <br />d. Describe how rinsagte mpterial will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Tr atment, Storage & Disposal Facility: <br />If I <br />Hauler Name Phone(I '/ T %) <br />2 <br />