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1. Site map enclosed <br />10 RETROFMOR REPAIR <br />YES NO[] <br />2. Spec sheets attached for equipment to be installed YES [4 NO [] <br />3. Description of work to be completed: <br />Dy -rs t n & &f ?14-e- 7-&&41e- 0i f -r= L Q Aw o aux.) 'Tv ' ►�4' ivy toco-n" s . <br />i _� '�� i - _ �• _ 1 /fir � <br />iAo s7,W <br />4. Description of equipment to be used: <br />� N l�! r 2�w�-- "t� J � �.Ise.� �v mPs � P c,� 1 �.+�,� r�c.T d.9-� ✓� — % .e ce,c� <br />�.�. 9, WHOM <br />�r <br />5. All equipment is State certified or approved. YES V NO [] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? ES NO [ <br />.b. Identify contractor performing decontamination: <br />Name�Phone) <br />Address (' city Zip !3 �1' !L� <br />C. Describe method to be used for decontamination: <br />-An <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />M <br />e.Rinsate Hauler and <br />permitted Treatment, Storage & Disposal Facility: <br />Hauler Name I k),, -- Phone) <br />2 <br />