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RETROFIT OR REPAIR 10 <br /> 1. Site map enclosed YES NO <br /> 2. Spec sheets attached for equipment to be installed YES r/ NO <br /> 3. Description of work to be completed: <br /> (_914pkS f_ 1. 0 rojO&-To(a Y F-V R LA P Gra-A <br /> A <br /> 2) <br /> 90M '!s;T— 7,-7 =6WT*'1n1 ­WS1_ 5'r-130 -roazb"F -TFsr- <br /> C 0 124P M4 aek- fWO 17 Sr U.s0 R:M) <br /> 4. Description of equipment to be used: <br /> EL>L- <br /> I'D ef- f6 <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 decontaminati : <br /> re Zva <br /> mo <br /> minati <br /> Name Phone( <br /> Address city Zip <br /> C. Describe method to be used fol ntamination: <br /> z <br /> d. Describe how rinsate m erial will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Haul/r and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name PhoneL <br /> 2 <br />