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RETROFIT OR REPAIR • <br />1. Site map enclosed YES NO [ J <br />2. Spec sheets attached forequipment to be installed YES [ ] <br />3. Description of work to be completed: <br />4. Description of equipment to be used: <br />NO � <br />�� 5,;✓,� ki 4 dcll� Cs <br />O X10+- l.e s ', ( - <br />5. All equipment is State certified or approved. YES [ NO [ J <br />6. Decontamination Procedures: <br />a. Will piping be dec ntaminated prior to removal? YES[] NO[] <br />i <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 rins to material will be stored onsite prior to manifesting offsite: <br />I <br />I <br />e. Kinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( ) <br />2 <br />