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RETROFIT OR REPAIR 10 <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 />4. Description of equipment to be used: <br />ins Lf A%e w yoe:Y 65s Lek #o 3141 '7 �oa'uca� <br />it sk t i lu e w "0, ► ac leaf FX 1 V I c Z�Pc6,ems, L,P -/3 /-7 <br />eS �/ occ7 V4Ayus5 Lo,, jC6y o 0 5p,,LJo603/c/7 <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 for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( ) <br />2 <br />a s cw l e s s <br />L Pte.lc A1Q+e- e.4W Z40o <br />r�,LAA <br />vao LojS Ukic <br />Oelec 4-01 Lbs <br />4. Description of equipment to be used: <br />ins Lf A%e w yoe:Y 65s Lek #o 3141 '7 �oa'uca� <br />it sk t i lu e w "0, ► ac leaf FX 1 V I c Z�Pc6,ems, L,P -/3 /-7 <br />eS �/ occ7 V4Ayus5 Lo,, jC6y o 0 5p,,LJo603/c/7 <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 for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( ) <br />2 <br />