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• RETROFIT-OR REPAIR* <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 /> q cSbexSerS 12R v ✓ 60 e 5 <br /> 57ei / 'De X -es. <br /> AJ L s e I //n u\\ � l / L �i o Tit (f 3 p % d 0-,-C/a dr e <br /> `J <br /> �Y- O -I&— -o "'- y- \T J o_. 6 c, ' e y r o c,e v� GC e -5 Q I 0. 'V�/�S. <br /> 4. Description of equipment to be used: <br /> FCb C- r (4-) C: / z a w c a 3 t l <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 [] NON_ <br /> b. Identify contractor performing decontamination: <br /> Name 1' ;', 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 />