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RET <br /> ROFIT.OR REPAI^ <br /> 1. Site map enclosed YESX NO <br /> 2. Spec sheets attached for equipment to be installed YE% NO [] <br /> 3. Description of work to be completed: <br /> oye 2X /S �i q NA 'L&A- oN��o !�` , <br /> (� p� T <br /> TIV .C G ,C/ Al) <br /> I5.�_o ,, e_- � � %a,v k i �7e,�-s�,' �i 0.. / _/�.a N� V o✓s � J1�� /c_e <br /> yo %7k 7a/ - iV c o N l'�-a SeN s o rS <br /> 4. Description of equipment to be used: <br /> zzv— C r- x� T C. o j.r s o /,e <br /> T S_P- 0 k S S e n/ s 0 <br /> 5. All r..quipment is State certified or approved. YE X NO [) <br /> 6, Decontaininatior, Procedures: <br /> a. Will piping be decontaminated ;prior to rF.iroval? YES [! <br /> b. Identity 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 /> /k'�/A - <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name / V Phone(__) <br /> 2 <br />