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RETROFIT -OR PAIR <br />1. Site map enclosed YES NO [ ] <br />2_ Spec sheets attached for equipment to be installed YES [ ]. NO i I <br />3_ Description of work to be. completed: <br />4-- Desc "ton of equipment to be used: <br />-o�? r--- <br />5_ Agh. equipment is State certiffed or approved. YES [ NO [ ] <br />6, Decontamination Procedures:.. <br />a- Will piping be decontaminated prior- to removal? YES j ] NO[] <br />b_ ldentify contract®r performing decontasminatign: - ----_ - — - <br />Name Phone( } <br />Address City Zip <br />C. Describe method to be used for decontamination: <br />o. Eiescribe t de V finsate material vall' be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility <br />Hauler blame Phone(_ <br />2 <br />