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RETROFIT.OR REPAIR <br /> enclosed YES 4 NO [ ] <br /> � , Site map / NO [ ] <br /> 2 , Spec sheets attached for equipment to be installed YE <br /> 3 , Description of work to be completed : LL <br /> 10 � n <br /> EI <br /> Zo �S� s . <br /> 6� <br /> v � p SDG DKQ� ' s t✓fZS �¢ ] '�`� LS ►yl <br /> 4 , Description of equipment to be used : <br /> 5 , All equipment is State certified or approved . YES NO [ ] <br /> g , Decontamination Procedures : YES NO [ ] <br /> a , Will piping be decontaminated prior to removal? <br /> b . Identify contractor performing decontamination : ZCo 7 �s7 <br /> ze 0 '1 � F [�TR� vTo � Phone lo( S (9 <br /> Name 773 <br /> b�lF� City io+� arr�IPS Zip <br /> Address <br /> Describe ltrod to be d fordecontamination: <br /> T� <br /> L <br /> d . Describe how rinsate material will be stored onsite prior to manifesting o s e : <br /> e . Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> asrE . Phone(_) 73Z ��ys <br /> Hauler Name./A R C4'I Up s <br /> 2 <br />