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RETROFIT -OR REPAIR <br />1. Site map enclosed YES NO [] <br />2. Spec sheets attached for equipment to be installed YES <br />3. Description of work to be completed: <br />NO [] <br />.►� -� -v e x r s ` f 141 01 �', fl �- tla-,G o v- '0/ u G <br />4. Description of equipment to be used: / <br />C � �-- <br />S <br />01P j% At o. N CG/ m jOS <br />All equipment is State certified or approved. YES NO [ ] <br />Decoibtamination Procedures: <br />a. Will piping be decontaminated prior to removal? VI`S [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name�� Phoneme_) <br />Address City Zip <br />c. Describe method to be used for decontamination: <br />d. <br />Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />IV int <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />K <br />