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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 />1Z E w&® v t,' <br />2 c A -c. <br />-t-W F— 83— <br />Ti c c. <br />S Pc C L <br />7 �T— <br />F�:7-A-r -ri+� <br />A A K v A2 7-" <br />T <br />® r— 8'/t 1 40 6 _ <br />4. Description of equipment to be used: <br />0 til W t S It C_ rr G L S P I L L �'s ►► A.' ,,L W, rt <br />5 <br />[:1 <br />All equipment is State certified or approved. YES NO [ ] <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name Phone(_) <br />Address City <br />C. Describe method to be used for decontamination: <br />YES[] NO[] <br />Zip <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 />