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• RETROFIT.OR REPAIR* <br />1. Site map enclosed YESX NO [I <br />2. Spec sheets attached for equipment to be installed YES[] NO <br />3. Description of work to be completed: <br />�" <br />Le <br />4 <br />5. <br />C. <br />Description of equipment to be used: <br />— 11 1 " I _ L Cil' _'_ ., <br />All equipment is State certified or approved. YES D4 NO [I <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES NO <br />[ ] <br />b. Identify contractor performing decontamination: <br />Name �� , �v.' Phones �— _) <br />�s ���-� city <br />Address � _� � � /� 13 Zip <br />C. Describe method to be used for <br />d/econta/mi at/ion: r <br />z o Ci 9 LJ/ / /L {? i i L rJ a^� <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 />v; c Phone s(=) 5�/� /a <br />Hauler Name �- `` <br />2 <br />