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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [I NO)( <br /> 2_ Spec sheets attached for equipment to be installed YES (] NO [] <br /> 3. p scription of work o be completed: <br /> `lees naCi0.✓s 1, t Sew�te. S+6-+O,4 SUstc-- is w�U bet a#e�tl�� a t <br /> t1iO4,0iM bcylyl -Ea eaus{iuc MC)ECi,-ovrAy c5-Ks4e1 dial- gut eoymtowcarftm <br /> —bus i�staUa�;o✓� uua u-.4,Lu,ee a. so�F-tu-ave, Iib avade, <br /> 4. Description of equipment to be used: \ <br /> VR 33o14q O0� oyc o�ewi boavd. (vic�Fu�e ei�citdf <br /> 5. All equipment is State certified or approved. YES' [ NO [] <br /> 6. Decontamination Procedures: <br /> a. Wilt piping be decontaminated prior to removal? YES [] NO [] <br /> b, Identify contractor performing decontaminatio . <br /> Name Phone( I <br /> Address z City Zip <br /> C. Describe method to bXud r decontamination: <br /> d. Describe ho ansate material will be stored onsite prior to manifesting offsite: <br /> e. nsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(__) <br /> 2 <br />