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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [4 NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO <br /> 3. Description of work to be completed: <br /> A_P P r(Z P 1-Z CA 14 VIA En ( A-c S S;rv�a c ( L� av- <br /> �s '4- S t-P 0 �P S E A-VA - <br /> 4. Description of equipment to be used: <br /> R- P TL"r -I WA k,T E R r A-t P PT- Ar� c. w rW <br /> S uywp IM A-T En.1 A-G S <br /> 5. All equipment is State certified or approved. YES [] NO <br /> 6. 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 />