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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 [] NO [] N l Ar <br /> 3. Description of work to be completed: <br /> P P C erz i-I TZ e-st t4 VK A-T-E2 c A-L -r-c) <br /> L E A-!L A-M <br /> 4. Description of equipment to be used: <br /> '1— (2- P 12 E Si 4 "I k P--F EA ( A-C S C c)PA P krA-B c,� w LrV <br /> 10 VA ASE-9-% A-C S <br /> 5. All equipment is State certified or approved. YES [] NO [ ] N I A- <br /> 6. Decontamination Procedures: <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 /> 2 <br />