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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 co pleted: <br /> 4. Description of equipment to be used: <br /> /)e%u." �- <br /> 5. All equipment is State certified or approved. YES'K NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YESN NO [] <br /> b. Identify contractor performing decontamination: <br /> ` L � <br /> Name .G� �ar L Dn�72W46 e( d�4) <br /> Address l/�3g s. /�A/� City a�J •�-O� Zip Q.S33a <br /> C. Describe method to be used for decontamination: <br /> e,- <br /> d. <br /> id. 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_2724 <br /> �° O/�.S PhoneLq <br /> 2 <br />