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0 <br />REiROHIOR REPAIR <br />1_ Site map enclosed YES [I NO E I <br />2. Spec sheets attached for equipment to be installed YES ( I <br />3. Description of work to be completed: <br />Al��1 <br />-00( - � <br />NO (I q t/ -GG 6 _ S— <br />01 <br />�- r�evYnntinn of ens rinmPnf to EiP s t�nri- <br />--LET 0 <br />5. Ali c,,;ruTr"er'i is State certified or apl. -oved. YES l I NO ( I <br />U_ Decontamination Procedures_ <br />a W ill piping be decont,uninated pi io: `;: removal'? YE`� (j X) I <br />b_ Identify contmictor peifo:ming decont<irnination: <br />Name-- - - Phones ) <br />Address <br />_City_ Zip <br />G_ Describe method to be used for decontamination <br />d. Describe how ansate material wiEl be stored onsite prior to rnar?ifesting offsite: <br />e_ Rinsate Hauler and permitted Treatment, Storage & Disposal Facility_ <br />Hauler (dame Phone j <br />e <br />i <br />2 i <br />