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RETROFIT OR REPAIR, <br /> 1. Site map enclosed YES [] NOK <br /> 2. Spec sheets attached for equipment to be installed YES [] NO�( <br /> 3. Description of work to be completed: <br /> U P G apM f TLS -35;0 rnco zTv�syJG SY 5—men To24- <br /> Ta F•u::.cam' .%►t �.it�A �t�nn M+r wiz arm v i3 F �e�: 5�,� Ac*Jh <br /> 4. Description of equipment to be used: <br /> Piu V R'3 3,.TO - 3d V <br /> t�-5 30 /Sae-rwrr yr.s £C Pu Z/iAl sz,+ -4sft I=t-)P- <br /> 5. <br /> c-)P- <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 [] <br /> b. Identify contractor performing decontamination: <br /> Name Phone(_ <br /> Address city Zip <br /> C. Describe method to be used for141mination: <br /> d. Describe how rinsate m rial will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hau r and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone( ) <br /> 2 <br />