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RETROFIT_OR REPAIR OF R A N 9'S 0 A)-E S T O P <br /> 1. Site map enclosed YES NO [) <br /> 2. Spec sheets attached for equipment to be installed YESX NO [] <br /> 3. Description of work to be.completed: <br /> S. w C v N C V, e. L <br /> u L OL /V 1� <br /> V A -/� a 2 Lz t2 C k L T S <br /> 4. Description of equipment to be used: <br /> t 1> IZ 1V i 5 H It N D r A/ 5 r <br /> 5. Ali equipment is State certif'i'ed or approved. YESW NO [J <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: I <br /> ()Pscrihe how rinsate rn:tom `4 ` e storm+ ors.te prior to manifesting offsite- <br /> N'// - <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name d Phone( <br /> 2 <br />