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1-1 :4 4:73 1 Z' <br />1. Site map enclosed YES NO 11 <br />2. Spec sheets attached for equipment to be installed YES NO <br />3. Description of work to be completed: <br />.17 L. # �-M* <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 Cay Zip <br />C. Describe meftd to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting oftite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: t -A <br />Hauler Narne- -- Phone( <br />IN <br />