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RETROFIT OR REPAIR <br /> 1: Site map enclosed YES [I NO <br /> 2. Spec sheets attached for equipment,to be installed YES NO[) <br /> S. Description of work o be completed. e e <br /> I e44 n c cL" o vvt !k t� Si&�O i4 5 S�IKtS w Z Q be- lt� -55 Ca- <br /> v' <br /> 4. Description of equipment to be used: <br /> VK 330144 - ®0o-- od-ewt 6a-V& i (e ei-c' d� <br /> 5. All equipment is State certified or approved. YES)4 NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal<(C YES [] NO [) <br /> b. Identify contractor performing decontaminatia Name Ph <br /> Address City Zip <br /> c. Describe method to be u d for decontamination: <br /> d. Describe ho ansate material will be stored onsite prior to manifesting offsite: <br /> e. nsate Hauler and permitted Treatment, Storage& Disposal Facility: <br /> Hauler Name Phone( ^) <br /> 2 <br />