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0 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO [1 <br /> 2. Spec sheets attached for equipment to be Installed YES NO <br /> 3. De ription of work to bepleted: <br /> q " r -S=iL_­-'� -A�_= 9� ':E <br /> Es rz- <br /> 4. Description of equipment to be used: <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: r-,A / 6.— <br /> Name PhoneC---_j <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: f'_1/P_ <br /> Hauler Name Phone( <br /> OT 'd L296V2629s H331HOONUO WUT0 :6 9002 T2 qaj <br />