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RE f ROFROR REPAIR <br />1. Site reap enclosed YES [ ) NO [I <br />2. Spec sheets attached for equipment to be installed YES[] NO [ ] <br />3. Description of work to be completed: <br />evCnptinn of srn�+enma..t to he used: <br />S <br />lrT./0-141 r s RWIMM »r �� ����• � � e ms.. <br />I wal/ �r j <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 [ j NO [ j <br />b. Identify contractor performing decontamination: <br />Name Phone( <br />Address City -- ZAP-- <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. Rinsatee-Hauler and permitted Treatment, St®rage & Disposal Facitiiy: <br />Hauler Name Phone(__] <br />