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RETROFMOR REPAIR <br /> 1. Site map enclosed YES NO [l <br /> 2. Spec sheets attached for equipment to be installed YES NO [l <br /> 3. Description of work to be completed: Ile <br /> C re-7eCi <br /> UCK -C' <br /> 4r d l -,e c.T/ o nJ O� v� o , T--4P- S . <br /> 4. Description of equipment to be used: <br /> OPS X10 ® F.,* <br /> l/ ►� ve 1vofJ <br /> �--p 7-7 s <br /> ------------ <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 /U Phone __) <br /> Address City Zip- <br /> C. Describe method to be used for decontamination: <br /> �E� <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 />