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RETROFIT OR REPAIR <br />1. Site map enclosed YES [ ] NO g <br />2. Spec sheets attached for equipment to be installed YES NO [ ] <br />3. Description of work to be completed: <br />aiL 0,4c�-�-ect qed- <br />4. Description of equipment to be used: <br />C o 0 &Ou- C -k c� SL--eei- <br />5. All equipment is State certified or approved. YES [4- NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone(_) <br />Address city Zip <br />C. Describe method to be used fo econtamination: <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 />071 <br />