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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 /> /1 a ct &V <br /> 4. Description of equipment to be used: / <br /> CIA <br /> V&O s-X�40;'6 <br /> Lb - ,;-'D D a t' h 0-� 60-n✓c►'S YVI 4-k- <br /> 4-.z,5-o6 <br /> -k-`]'-25•o6 -1 es if t (Q Wz e E) 030 20%70 <br /> 5. All equipment is State certified or approved. YES [4---" NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor <br /> performing decontamination: <br /> Name 1� �OYI Q� ) '1/V. Phone() 462/-63E <br /> Address C1q81an(17 city ILZip Q <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 />