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_ r <br /> RETROFMOR R PAI <br /> 1. Site map enclosed YES [I NO <br /> 4% <br /> 2. Spec sheets attached for equipment to be installed YES NO [] <br /> 3. Description of work to be completed: <br /> ?sm�xrr Gt�� �e�1aGe fl�SPe RE'S ; Sheaf V0.\c eS,�e S e �C'v <br /> 1a �- ucn�s list L (�QofC�C_2Y111Qtb� ����d1Q <br /> n S D `I b e,.- u0c, sL1l—o <br /> a f <br /> � �V � s <br /> 4. Des ription of equipment to a use <br /> v�oy�eC vim- 1�v4cS c Q AA- <br /> Adt <br /> (� Fili Q or' ca 6120-4100 S vest-Uq�� <br /> 5. All equipmedis Sate certifi dor approved. YESX NO [� <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES NO [] <br /> b. Identify contractor performing decontamination: <br /> Name ^ �CS"1 • Phone J <br /> Address ���� '�.� x�E'�L �(' City Zip-95-21 <br /> C. Describe method to be used for decontamination: <br /> Q,- - �'�i,n.�,l`[� tis -�i\1�_S�►, .c\c <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> .S At <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(�9 )SLIY 0 7q <br /> 2 <br />