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7-n3; 5:zaM:ss�ramenz� EMC <br /> RETROFIT OR REPAIR <br /> 1• Site map enclosed Yes ❑ No ■ <br /> Z. Spec sheets attached for equipment to be installed Yes LI No M <br /> 3. Description of work to be completed: <br /> Furnish necessary material &Haber to install audible visual overfill alarm on existing Veede -Root <br /> stern, <br /> 14- Description of equipment to he used: <br /> Y #790091-003. Veeder-Root Overfill alarm <br /> 5. All equipment is State certified or approved, Yes ■ No C-3 <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. i2insate Mauler and permitted Treatrnent, Storage &Disposal Facility: <br /> Hauler Name, Phone:'(----) <br /> Hauler Registration # <br /> Address: city: Zip. <br /> Permitted Dlsposal Site: <br /> y. a. Descrlbe the method that will be utilized to purge and/or inert the piping: <br /> lBE d x700/900 d Otati-1 E9E9 ZEE 30Z 901E2 al 'ss!og 0p10-d HTM-Woad 9:80 0 EO-OI-qad <br />