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— r ver �va.r� VJ. •..IL LV JIVVJIVJ <br />1. Site map enclosed YES [ ] <br />r i r In r L-uuM <br />RETROFIT OR REPAIR • <br />NO[] <br />rAUL b4 <br />2. Spec sheets attached for equipment to be installed YE NO [ ] <br />3. Description of work to be completed: <br />�'(�- ►� � 02yPCa-- O A -mil <br />4. Description of equipment to be used: <br />5. All equipment is State certified or approved. YES�z NO [ ] <br />6. Decontamination Procedures: Q <br />� IN, <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 />