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• RETROFIT -OR REPAIR <br />1. Site map enclosed YESX NO [I <br />2. Spec sheets attached for equipment to be installed YESX NO ( ] <br />T H,F F � h,., comp!etpd <br />N r• t_ __. <br />IF, <br />4. Description of equipment to be used: <br />L C c P /47 TT AC. H.ED. <br />5. All eciui3ment is State ce rtified or approved. YESX NO [I <br />Decontamination Procedures: <br />�1/A YE <br />. , <br />Will piping be decontaminated prior to removal? S [ ] NO[] <br />,Ucjjtify contractor performing CiPr"(:s )/A <br />Name Phone( ) <br />Address City Zip <br />C. Describe method to be used for decontamination: N <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 I Y / Phone() <br />t4 <br />