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1 <br />9 <br />C1 <br />Site map enclosed YES [I <br />RETROFIT OR REPAIR 19 <br />NOeV"' <br />Spec sheets attached for equipment to be installed YE^�J NO [] <br />Description of work to be completed: <br />4. Description of equipment to be used: <br />I�PW Darec-T (aur EY Sysrvt r 7w-, GZIiF/ wry <br />5. All equipment is State certified or approved. <br />6. Decontamination Procedures: <br />NO [ ] <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. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />2 <br />ThP(S?. <br />r <br />'-5-vR Mer <br />KdA-Tori 11 <br />e-) r rLeA5E <br />f9t�nei; <br />3_ C� <br />D�PoS:4L <br />�xh�b,'r N <br />�" �r <br />dei�fif �-eP deScf r p <br />r r n,� <br />4. Description of equipment to be used: <br />I�PW Darec-T (aur EY Sysrvt r 7w-, GZIiF/ wry <br />5. All equipment is State certified or approved. <br />6. Decontamination Procedures: <br />NO [ ] <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. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />2 <br />