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RETROFIT EPA* <br />1. Site map enclosed YES [ ] NO Df <br />2. Spec sheets attached for equipment to be installed YES <br />3. Description of work to be completed: <br />NO [I <br />TZ E P C A --c. -rA-,4 <br />rC <br />X K t4v C <br />kn- C E o a s o n- <br />?"t T A -N <br />U RL t r C C. <br />A- IAC ti( <br />V A- L Mot <br />t T"o (L 1 &- C. C� C�n�T <br />/ F (C A -J r" <br />4. Description of equipment to be used: <br />200-t- SE tics or. l/2 9 <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 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 />