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t •inn rc 1'', Ppl4E x 03 4• <br /> ;� �4 .��� kr i� �f �.."�Rh �, <br /> °��'�;�a �;;� <br /> ,' > onu4R REPAIR <br /> h <br /> 1 Site map endosed YES j Y NQ <br /> �2. Speo sheets atJt t+ ed fogy equipment to be installed :'YES O NO[] <br /> a."4'Y.1 A7'F <br /> 3 ;� <br /> I ption work to completed: <br /> Ri <br /> e .. <br /> Cb <br /> 1 If <br /> z jail <br /> At ChAl <br /> 4. Description of equipment to tie used. <br /> L..^ fZd a <br /> 5. All equipment is State c ardfled of ppproYed YES NO [ <br /> 6. Decontamination Procedures <br /> a. 1Alill piping be decontaminated prior to removal? YES[] NO [ - <br /> b. Identify contractor performing decontamination: <br /> Name` <br /> Ph <br /> ., . , '.one(_ _, <br /> Address City zip <br /> C. Describe method to be used for decontamination: <br /> .,. ..,^ a#X Wit+' R� ,•c', th`'v=tP+- ,x t;; t r t :__,: <br /> d Describe how rinsate material will be stored onsiteP dor to manifestingoffsite.- <br /> e:' R nsate Hauler and permitted Treatment*"$Wrage& Dispos a i <br /> Hauler Name Phone <br /> f <br />