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10 RETROFIT OR REPAIR 0 <br />1. Site map enclosed YESA Pq NO [ ] <br />2. Spec sheets attached for equipment to be installed YES NO [ ] <br />3. Description of work to be c, mpleted: <br />l ,n <br />�or 10A 41e, Fill and Me darnac riser, Roducf Spd/ btAj w,*#,ndude. t=0� <br />Amlil unjve.t PIT &c 00 e l and 0amlork oup. ?Crl�rm i►�i2Cl6cl`i'on besflhn yrs r�red <br />lou Gcfrufi -e ader Vie -1 cd -L5 . 431 bath & hl*+eSi3, and a %nk 1hfen rih f�esf as <br />�C'orr i ✓ed W W o . 14M Nui-AouS Late ntmemtvi ivill be clisraar��-d of utit UN's <br />+2it WMrd6u &45ke Mdnq-emen+,b i5fon <br />4. Description of equipment to be used: <br />Cxccwhdc, tlfd-ey12-169--6 (SPX a ch,,,J Spec Sheei�!,) <br />5. All equipment is State certified or approved. YES NO [ ] <br />6. Decontamination Procedures: /U <br />4— <br />a. Will pi%cont <br />econtaminated prior to removal? YES[] NO[] <br />b. Identiffor performing decontamination:/ <br />Address <br />C. Describe method to be used for <br />ones) <br />City Zip <br />mination: <br />d. Describe how rinsate matefial will be stored ol9site prior to manifesting offsite: <br />e. Rinsate Hauler d permitted Treatment, Storage & Dis <br />Hauler Name? Phone <br />2 <br />Facility: <br />