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0 <br />.O REPAIR <br />1. Site map enclosed YES [I NO [I <br />2. Spec sheets attached for equipment to be installed YES [ j <br />I Description of work to be completed: <br />am <br />h c,--- Il".1�2d4��L Por* 0 be 1! S A <br />My <br />4. Description of equipment to be used: <br />/C/ S#- 2 ' <br />5• All equipment is State certified or approved. YES NO [ j <br />econtamination Procedures.- <br />a- <br />rocedures:a_ Will piping be decontaminated prior to removal? YES [ ] NO [ j <br />b. Identify contractor performing decontamination: =--------- _ <br />Name Phone(__) <br />Address city Zip <br />C. Describe method to be used for decontamination: <br />d_ describe ha:�isat r�. `r-Tialwill he stored onsite prior to manifesting _o ?site: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Blame <br />2 <br />