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1 <br />2 <br />3 <br />RETROFIT OR REPAIR <br />Site map enclosed YES [I NO', <br />Spec sheets attached for equipment to be installed YES° <br />Description of work to be completed: <br />GAJC.G SYST IA . <br />`ifA►J�- 6AU&E 5 Sr-E� <br />NO [I <br />4. Description of equipment to be used: <br />V` / CaN S�� - 1 ��� 5 6 ) <br />i✓Ed�iL- �oo � TCS 350 <br />J�ED£aZ I cT /4A4 N&`r0kESTP-1C T ► ?(�u, 6cS I pFlz TA IJV- <br />C3� <br />N+E25T1%t2.So2S- ?E�2 rA� K �3J <br />��EDc� 4Ccc� �U�tP ni5p25- I PC2 �K ►J� ' Pe --le- DtSPC-"j <br />5. All equipment is State certified or approved. YES NO [ ] <br />6. 44 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 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 />