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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/or retrofit existing OPW/Pomeco EVR spill bucket on(87)Chevron Regular& <br /> (91)Chevron Supreme fills. <br /> 4. Description of equipment to be used: <br /> existing OPW/Pomeco EVR spill bucket <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 /> Ell 23 046(revised 124/02) <br /> c,,01, ,hs3-eh23U46apd Page I Woft121718 <br />