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TOFIT.OR REPA110 <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YE NO [] <br /> 3. a des-ription of work to be completed: <br /> IV C V- a-y`_®ce/v c� <br /> 4. Description of equipment to be used: <br /> 61/ > s � 6 c �. tF-- V /z- <br /> equipment is State certified or apprcavcd. YES NO [] <br /> econtarnination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] <br /> PCO <br /> _ b. identify contractor performing decontamination: <br /> Name Phone______) <br /> Address City Zip <br /> c. Describe method to be used for decontamination: t <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Haul erand permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(—____) <br /> 2 <br />