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RETROFIT,OREPAIR+ <br /> 1. Site map enclosed YES K NO [] <br /> 2. Spec sheets attached for equipment to be installed YES ( NO [] <br /> 3. Description of work to be corn I ted: <br /> 1'FFw,nnr) �'�n� C cz.N <br /> s' <br /> 4. Description /of equipment to be used: <br /> F' O��lr ria-ch <br /> errrout S o-r� Z 112 <br /> G -�- <br /> 5. All equipment is State certified or approved. YES NO [] <br /> g. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES <br /> b. Identify contractor performing decontamirYation: <br /> Name /`'`� <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 />