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RETROFIT -OR REPAIR 0 <br />1. Site map enclosed YES [ ] NO <br />2. Spec sheets attached for equipment to be installed YES <br />3. Description of work to be completed: <br />(ST/ <br />a nt A) n cn/ 6 V_/Z, leo s . -7'--1 v 2 / <br />CL re l es <br />4. Descriptionot equipment to be used: <br />LOP tv 0/ -AC C O <br />/< a Ts <br />5. All equipment is State certified or approved. YES; <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />NO [ ] <br />i <br />i CCC ze <br />n b L& V' / 7 <br />NO [ ] <br />YES[] NO[] <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 />