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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 t4 NO [] <br /> 3. Description of work to be comple ed: <br /> P H f+� P 2 0- /2 <br /> 9NC� l�Ae iy., nr -3Vmz 6-0w lgg! Ag,_.� <br /> C522ni cwe�� <br /> �« 7v <br /> 4. Description of equipment to be used: <br /> 01? l 'Ll ot> 7Tbtaihri A4r/ S4,,e- �4"_ xAl ger- BOu) (a <br /> �r�i OAp��7dw i72on��.�rAGSCe Ocyi✓�'L- ficL� <br /> �D.9]rr77z°� �� Aoyy�2i��Ds <br /> 5. All equipment is State certified or approved. YES NO [] <br /> 6. Decontamination Procedures: 01,14— <br /> a. <br /> /,14—a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name 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 />