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• RETROFIT OR REPAIR • <br /> 1. Site map enclosed Yes ❑ No ■ <br /> 2. Spec sheets attached for equipment to be installed Yes ❑ No ■ <br /> 3. Description of work to be completed: <br /> Furnish necessary material & labor to repair / replace #400988932 FE Petro check valve <br /> and/or#848480-001 Veeder-Root Pressure Line Leak Detector (PLLD) on (89)Chevron Plus <br /> 4. Description of equipment to be used: <br /> #400988932 FE Petro check valve <br /> #848480-001 Veeder-Root Pressure Line Leak Detector(PLLD) <br /> 5. All equipment is State certified or approved. Yes ■ No ❑ <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? Yes ❑ No ❑ n/a <br /> b. Identify contractor performing decontamination: <br /> Name: Phone ( ) <br /> Address: City: Zip: <br /> C. Describe method to be used for decontamination: <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: Phone: ( ) <br /> Hauler Registration # <br /> Address: City: Zip: <br /> Permitted Disposal Site: <br /> 8H 23 046(.,iced 1'24/02) <br /> PapR <br /> cAsJYfpArepihs3-ch23046.mPage I WO N121718 <br />