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il <br />2. <br />3. <br />CI <br />I: <br />A <br />0 <br />Site map enclosed YES D9 <br />RETROFIT OR REPAIO <br />NO [I <br />Spec sheets attached for equipment to be installed YES I4 NO [I <br />Description of work to be completed: <br />"D(ESS1acoAr2 - q -,,c,,4 vA-(- S 899 y TF -V <br />A 1-0 B e- <br />�tSP <br />• X .4 vATF- A -T- 't�rsP • # ��Z � � 9 C A -t -E r 2RPA-irz L E A -K <br />Description of equipment to be used: <br />V X te- x o w P4 - F X P &C'T G E A -Z -t-o 13 a A- r1:::- c r- x Ro B T a 2 <br />• 'Pt P I AJ <br />All equipment is State certified or approved. YES K NO [] <br />Decontamination Procedures: <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 />