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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 /> 5 n"-,o V o c- ck 1 O �- <br /> 4. , Description of equipment to be used: <br /> \�eeAt<- Dq '4190 - `toG S2rsc� r <br /> �--i C b�3 <br /> 5. All equipment is State certified or approved. YES P4 NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Ej�� y Co��(-C,C��ff Phone <br /> ��OC�� rl <br /> Address \�WcR,M 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 />