Laserfiche WebLink
0 <br />RETROFIT -OR REPAIR <br />1. Site map enclosed YES [ ] NO [] <br />2. Spec sheets attached for equipment to be installed YES [ ] NO [ ) <br />3. Description of work to be completed: <br />O. rC� Q_ t___c,1 c, cA e 4 o 0(- o n 0 C+ 7 1 <br />4 PnninmPnt to he.Jcar_e <br />5. Al} equipment is State certified or approved. YES] NO j ] <br />D -contae ination Procedures: <br />p,Fiij ,'-,:- decontaminated prior ro rernoval?' <br />b. i 'en ify con' ctorperforuf,14decorstaminaiion: <br />Name—__ <br />Address_ <br />C. Describe method to be used for decontarninatior,. <br />d. Describe how rinsate materia} will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />—Phone(_) <br />