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v RETROFIT -OR I R <br />1. Site map enclosed YES [) NO[] <br />2_ Spec sheets attached for equipment to be installed YES [ j <br />3. Description of work.to be. completed: <br />4-- Description of equipment to be used: <br />CC`s <br />5_ AJI YES_ equipment is State certified or approved, YES[] NO [I <br />6. Decontamination Procedures:.. <br />a. Will piping be decontaminated prior- to removal? YES [ ] NO [ <br />b. ldentify contractor performing decontamination: -_--__-- -- -- <br />Name _ Phone( ) <br />Address �. City Zip <br />C. Describe method to be used for decontarnination: <br />d_ `®escribe hc�v rir sate material Yrillbe stored onsite prior to rnanifesfing.offsite;- <br />e. Rinsate mauler and permitted Treatment, Storage & Disposal Facility. <br />Hauler Name Phone <br />2 <br />