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nes z=u u't uo: i�a uarrna arawn •'•"" , "" """ r• y <br /> RETROFIT,OR REPAIR <br /> 1. Site map enclosed YES[J NO (J <br /> 2 Spr?c sheets attached forequipment to be in,ta:;ed YES () tiff[J <br /> 3. Dw-cop50n of work to be completed: <br /> ..__t)LQ c. Q l CL. _y'Yl002_ C2)ci <br /> Ab, a�vcv.z.� off. �T Sal ci l OCi- C'p 1C\N r <br /> 4. Des rrption of eeunmeat to be used: <br /> GNk <br /> -___._ ` <br /> i <br /> 5_ AJI equipment is State certified or approved. YES[] NO[J <br /> G_ Decontamination Procedures: <br /> a. Will piping be decontaminated prior»removal? YES[] NC? i i <br /> b. Identify contractor performing decontamination: <br /> Name Phone(_} <br /> Address City Zip <br /> C. Describe method to be used for decontamination: <br /> J. Descciae how rin,..ate. material vidl be stored onsite prior to manifesting o1fiAe. <br /> i <br /> e. Rinsate Hauler and permitted Treatment,Storage& Disposal Facility: I <br /> Hagler Name <br /> i <br /> i <br />