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0 RETROFIT OR REPAIR 4k <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 /> AOp 1)itsZ.So`p- To &34groSrrt77vAA %y 4oL1y6R.TimI 'j-M 15u0eyLU LlLeAago <br /> LI ST To o r es t-c.. CodyfzRL Mj H iu 6 x^oL- Q-jr To S 012,9- W lcANEC). iZ 'PLAGI; M M V/sp v2 t <br /> w;zti Osw 'S*l Mut-j%PuvacT 1BLC41Djjr4 OrsAc�SsrAs, UPqp;ut (6-� Tcs 'Iss-c Fid A.�d <br /> sanau— view Lrii,r-o -5emisvits ;-i (0 va&. (E) T"►se 1 •I-X i PHA3C.�1- <br /> T'o RE gisAt3LLZD K6 Euc+e►vAiro� OiL Remoo'At- eF U G., pips4 f 9&PE!seM0 <br /> 4. Description of equipment to be used: <br /> IBJ-Zw �+.IcoR-�' 3ov SaRi6s 3+l Nu�Ti-��¢oc�T t3«upr�ry c�r�a►1s4� <br /> 1.1 �Ictbt ��-r L�g�IrpsccfloR- ` �E) <br /> 5. All equipment is State certified or approved. YES [►�]� NO [] <br /> 6. Decontamination Procedures: /v(F} <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 Phone( ) <br /> 2 <br />