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• <br /> RETROFITOR REPAIR <br /> 1- Site map enclosed YES [j NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed: <br /> ice c. o.�� UA CC MoL)e r) <br /> b"ACV e"�-� or, Rif ASI G 1 OCA- ro\Ck C Q t���►�. <br /> Y12�J b ke r cue (J�� o 00ne ee <br /> I <br /> A_. r,Jecrnntinn of onninmont to ho IIsed- - ^_ <br /> _.. <br /> ic.K) F) Yla\ re c 0,C\ _e <br /> 5- AN equipment is State certified or approved YES [j NO[] <br /> i <br /> 6_ Decontamination Procedures: <br /> a_ Will piping be decontaminated priorto removal? YES [j NO t <br /> b- Identify contractor performing decontamination: <br /> Name Phone( <br /> Address <br /> City Zip <br /> C_ Describe method to be used for decontamination: <br /> d" , Describe how ansate material will be stored onsite prior to manifesting offsite' <br /> i <br /> j <br /> e_ Rinsate.Hauler and permitted Treatment, Storage& Disposal Facility I <br /> i <br /> Hauler Name Phone( <br /> i <br /> � i <br />