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1 <br /> RETROFIT-OR REPA! <br /> 1. Site map enclosed YES NO [ <br /> 2. Spec sheets attached for equipment to be installed YES NO5 OL [ <br /> �WCpt�E?n ��S.�rrrrke itG Ci,r l ii,.Gi'i`C?{�' <br /> Cx <br /> 4. Description of equipment to be used- <br /> A" i� 'na nt is State certified n apf.;- �ved. 'ES NO <br /> e [� <br /> Ue;;.-)r -.amination Procedj-.-es: <br /> Will piping bL decontaminated prior to removal? V/A YcS [1 iVU [} <br /> - <br /> ::. <br /> Name A Phr,ne(—.�__) <br /> Address City Zip <br /> C. Describe method to be used for decontamination: <br /> d Describe how rinsaie material will be stored onsite prior to manifesting offsite_ <br /> X/ 11A <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name_ ]`�/ Phone(_) <br /> 2 <br />