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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 /> �v`s�allo coN ��a �1 �l�S LO&YA T s� e-0OVL - <br /> yU�e i t u cC l'�u 1�2V 4t LC.��`ULA&k4 <br /> �S� u.bavu ale <br /> 4a Y►a au,i�m ids a�►�n <br /> 4. Description of equipment to be used: <br /> sig-ifs . <br /> 5. All equipment is State certified or approved. YES' q NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br /> b. Identify contractorperforming decontaminations <br /> Name Phone( <br /> Address 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 />