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. RETROFIT OR REPAIR • <br /> 1. Site map enclosed YES [ I NO O <br /> 2. Spec sheets attached for equipment to be installed YES [y NO [] <br /> 3. D scription of rk to be com Meted: � � � �_� <br /> Qo� (a ���,04n�w tin" wh �A L 1�t U1.nw <br /> U��'1i�� �1k14. ]L��, -fh��, i� nu.� ���„�,►>JP. � cl.�.Q, G <br /> � tln �� �`` .� �a �)&h <br /> a ti �� , as <br /> ��1QhQa �lA9 l NY1 +11t91 03V _�M AJU )h 161V1 <br /> (4 11 o- WM angkits >a <br /> 4. Description of equipment - <br /> to be use&- <br /> (�� �Oorlu�, ` �1R+��So• ao6 ,��;�a .'Sump ��D,� v� la. � CeJol.e, <br /> (44) :�Une,,6n baht niPplL�) <br /> 5. All equipment is State certified or approved. YES NO [] <br /> 6. Decontamination Procedures: tiller &00)'a �j �l�C w��kirv&i&n <br /> a. Will piping be decontaminated prior to removal? U 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 Phone( <br /> 2 <br />