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1. <br />2. <br />3. <br />13 <br />b. <br />RETROFITOR REPAIR <br />Site map enclosed YES[] NO [ <br />Spec sheets attached for equipment to be installed YES (J. NO [ j <br />Description of work to be completed: <br />Description of equipment to be used: <br />9 q5K) Lyh 10 ZQLI��' <br />1 <br />All equipment is State certified or ; proved. YES NO[] <br />l <br />DecontaminationProcedures: <br />a. Will piping be decontaminated prior to removal? YES [) NO <br />b. Identify corrttactor performing decontamination: _ <br />Name Phone(_=} <br />Address city - Zip <br />C. Describe method to be used for decontamination: <br />d_ Describe hdv� 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 />N <br />