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RETROFIT OR REPAIR <br />1. Site map enclosed YES�D< NO [ ] <br />2. Spec sheets attached for equipment to be installed YES [ ] NO [ ] <br />3. Description of work to be completed: / AJs,r,4 ( (_ /1jE2,j ✓+(10 p LES 5- <br />L- <br />L- I tJ t L �=- A -(L D E rte C M (z, D 16 CZ <br />LLD TO <br />4. Description of equipment to be used: <br />�/ <br />1�A'(2,0R—LC--,s <br />5. All equipment is State certified or approved. YES/K NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? �'�s) YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <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. <br />ffsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility.- <br />Hauler <br />acility:Hauler Name Phone( ) <br />2 <br />