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RETROFIT OR REPAIR <br /> 1 . Site map enclosed YES [ ] NOR <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO [4 t,4 A <br /> 3. Description of work to be completed: <br /> • 2 E-T- E S T- O F l " Kz I E DSL I - <br /> • T4 i s Lb f7A-t L It-p -r"-r b v&, -r-c fi X c s s <br /> /a i rZ C�U ot-P ? A( s 'T—A-C C a p S I P i4-c*( <br /> a-y F, L D <br /> 4. Description of equipment to be used: <br /> �_! cr-LE <br /> 5. All equipment is State certified or approved. YES [ ] NO ( A <br /> 6. Decontamination Procedures: M ('�' <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 />