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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 [ ] <br /> 3. Description of work to be completed: <br /> Tns-i'nkk fZSa39L e �v►rn ��c��tir<� b�1arc�, y'e��Qe;-�Oot Pexc+ 4• 01'bOA- eol, <br /> �v\Av :Xis+, +1!� Leede( Imi TL! 3So +A4 MCIlk . r k <br /> A10 r -40 5-tort P_0.S. syS-fir-y-\ - �\C!tf m ek(k re -[AYlk' <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES [] NO [ ] <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 />