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0 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 />iG,C.k bc;rynry,o r ©t, S�z C <br />c tL. Co Y1C r��� <br />equipment to be used: <br />Jr <br />� A <br />5. Ah equipment is State certified or approved. YES [I NO [I <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 ririsate material will be stored onsite prior to manifestinn offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone(_ 1__ _- <br />2 <br />