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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ NO [ J <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO E-J' <br /> 3. Description of work to be completed: <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? �k / YES [] NO [] <br /> b. Identify contractor performing decontamination: �'1 /P. <br /> Name _Phone(_ <br /> Address city Zip <br /> C. Describe method to be used for decontamination: 1v /P� <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: t,-A <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(__) <br /> 2 <br />