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RETROFITOR REPAIR <br /> 1. Site map enclosed YESK NO (j <br /> 2. Spec sheets attached for equipment to be installed YES NO [j <br /> I Description of work to be.completed: e <br /> ria 0 V �Xf -6t/ ' Zccc 4e .5. <br /> S �'cL / ( G'' �' tit! _ ..� � �. (r f�� :.a ® v` �z� r• � � �s <br /> .1 ,,j -5 7—c, !( 6 F bt/ Pea s-,,7 v -e G� � e v- �� �/ `-P✓ ems7i0A/ <br /> 77� lues . env_. L CcA{- CQAj <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES NO [j <br /> 6. Decontamination Procedures <br /> a. Will piping be decontaminated prior to removal? YES [j NO [j <br /> b. Identify contractor performing decontamination: - ----------_ <br /> Name Phone( } <br /> Address city Zip <br /> C. Describe method to be used for decontamination: <br /> 1 Describe h6W r=neat material will t o stored onsite prior to manifesting offsite" <br /> A///4 <br /> e. Rinsate Hauler and permitted Treatment® Storage & Disposal Facility: <br /> Hauler Name _F-4,.)ne(-- - <br /> 2 - <br />