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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 /> / lAeM.pr- Tesr <br /> _A6 S <br /> g9 , 91 Auk <br /> g9 , 91 s �D <br /> 4. Description of/9 equipment to be used: <br /> G�i z M all / <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 M NO [] <br /> b. Identify contractor performing decontamination: <br /> Name�/Yoo� S /L/�1L55 hhoneLOAW_'� 3!;��S"O <br /> Address city d0 Zip 4� <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> 72 5 <br /> e. Rins�ate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Nam eH N l c oN5 —Phone( <br /> z <br />