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T �f <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO [ ] <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO'P; <br /> L&3. Description of work to be completed: i) ! <br /> �-� G (!Lp� N`�•- � <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES(M NO [ ) <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NOIK <br /> b. Identify contractor performing decontamination: <br /> Name !Vl C, . Phone( <br /> Address Rt- '9 �� s- city sib'c6 Zip 9 <br /> C. Describe method to be used for decontamination: p <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 /> TO/T0 3SVd 0003 SdS 3N0 d 9TL0888GK Z9:TT 900Z/TT/80 <br />