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C'_adbt. h 1F Ifl I L•_+Llf' I'k14— 0 <br /> ,f RETRO IT C)R REPAIR <br /> �. Site map enclosed YES rT/ No [ ] <br /> JAN l77Z003 <br /> 2- Spec sheets attached for equipment to be insla€led YRS [ql NO I I ENVIRONMENT HEALTH <br /> 3. Description of worts to be completed: PERMITTERVICES <br /> K t - U � - P k P r L-L... NI-::-VIA UECe . <br /> c D�t`t f� t rA rnnc <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES [ NO [� <br /> B. Decontamination Procedures: <br /> a. Will piping be decontaminated pririr to removal? YES ND [j <br /> L Identify contractor performing decontamination: <br /> Name Phone 220CID 0 <br /> Address 0� � �� City LID 0 L".�Zip- 1 �� l <br /> C. Describe method to be used for decontamination: <br /> ALL_ tai P i riG, N t LL. P� R t t d_g ' D 1�a NC-i t -�D 50 Gyp L . Pro-UM <br /> 0 ff W r°+Tz�t!1 -1 ❑er > <br /> d. Descritae Clow rinsate material will be slored,onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility.- <br /> Hauler <br /> acility:Hauler Name rEOt?41,F- VA. L 1�1 �I1JC�Phorre�) -O <br /> �'"w,E-A��CT Lam\U <br />