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RETROFIT OR REP <br />1. Site map enclosed YES [] NO D4 <br />2. Spec sheets attached for equipment to be installed YES [ ] NO'0 <br />3. Description of work to be completed: <br />XC A V A -r IF- p, -T" V E T 2 (S E !L A-rz C 4 -1-0 '�> E -,T 1:2u., <br />F I F T 2 U C !G <br />2 p L .A -r r,__ VF-, 1L -T S T A- ti1A) ►.(� S T Fit- U E► j2 (s t. <br />4. Description of equipment to be used: <br />5. All equipment is State certified or approved. YES [ ] NO [ ] p4 1 A <br />6. Decontamination Procedures: 141 v, <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 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 />