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# 16 <br />11111 11 111111 111 <br />7771MUT7I =--3::: = - I Mg MMEE�� <br />1. Site map enclosed YES [I NQ <br />2. Manufacturers spec sheets attached for all equipment to be installed YES [ ] NOII� <br />r <br />all= <br />40 1, 4 <br />4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br />5. All equipment is State certified or approved. YES [ ] NO [ ] <br />a. Will piping be decontaminated prior to removal? YES[] NO[] <br />b. Identify contractor performing decontamination; <br />Name PhoneL__j <br />Address CRY --4ip <br />M5 I N.M. ='• <br />- <br />a. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone(j Hauler Reg#_ <br />Address city Zip_ <br />Permitted Disposal Site <br />b. Piping Hauler <br />Name Phone <br />Address city Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phon- <br />A••- <br />Address city• <br />EPA III (if transported to a permitted TSD facility) <br />n-NITT <br />NTYA 10311 MV-1114FLOAU A A - 6 6 0 0 1-1-1- <br />AKU-1114FLOAMI <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone <br />J - <br />Address city_ zip--] <br />b) If soil is not to be hauled, describe what will be done with it <br />0 <br />