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1 <br />2 <br />3 <br />Site map enclosed YES [ <br />RETROFIT -OR REPAIR <br />NO[j <br />Spec sheets attached for equipment to be installed YES <br />Description of work to be completed: <br />NO [I <br />G /2 2 N e V O, N off- ,6 /a -C C_ ! /V <br />4L W <br />G�ec"��Y- <br />e�e.c-Ti �_ se NS ors 0- "'J"7( r -"L ro rangy. <br />Q_ r�ocyrantinn of an��inmvntt� hP sscc�ri- <br />S <br />b_ <br />_y ,e a e v. o o s .�. s e nv s o ISS a S. nV e ewe, ",e _ <br />T y'S Y, %. o�J S eNSorS cx s �ee� <br />% <br />e� .e y- e o _Gid a. rvt G�y- a»y- t ..a ►^ / N / �l'tS 0' O a ✓ <br />- a T <br />All equipment is State certified or approved_ YES [I NO j ] <br />Decontamination Procedures: <br />a_ Will piping be decontaminated priorto removal? YES [ j NO <br />fi_ identify contractor performing decontamination_ <br />Name Phone( <br />Address <br />City <br />C_ Describe method to be used for decontamination_ <br />X/ 1A <br />d. Descfibe hnw ririsate material will be stored onsite prior -to manifesting offsite: <br />-e v at N�- �a� b e le- k/ M. -Z7 <br />. <br />e_ Rinsate.Hauier and permitted Treatment, Storage & Disposal Facility_ <br />Hauler [dame (J N )<N e W N a-�� /ri f.e- Phone( . <br />K <br />1 <br />