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• RETROFIT OR REPAIR • <br />1: Site map enclosed YES <br />2. Specsheets attached for equ"ipnient. to be installed YESA NO [ j <br />3.' D sc 'ptign gf,work to be completed:: <br />1ecnncCl0,vtn -F^awt skins- WEU be Ctusl uitrg <br />tg e.a&I boa -0- -604 ski vr wtou j four -Eo v 6 Ff st fe ! dtcil- � � ea u tw �yttitc <br />4. Description of equipment to be, used: <br />VR .3301�+q — ©0 ` '-�a z< rko�evvl bmavGl Cvic�fv�e eiaCi&-�ed ) <br />5. All equipment is State certified or approved. YES' NO [I <br />6. Decontamination'Proceduies. <br />a. Will piping be decontaminated prior to removal? YES[] NO[] <br />] <br />b..:.: Identify contractor performing decontaminatlo . <br />q.Name ZPhone(L_)_ <br />Address city Zip <br />c. Describe method t6bXud r decontamination: <br />d. Describe h msate materlal will be stored onsite prior to manifesting offsite: <br />e. nsate Hauler and perrrmitted Treatment, Storage & Disposal Facility: <br />Hauler Name _ Phone( ) <br />2 _ <br />0 <br />