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• RETROFIT.OR REPAIR* <br /> Site map Enclosed YES <br /> NO [] <br /> 2. Spec sheets attached for equipment to be installed YES <br /> NO [] <br /> 3, Description of work to be completed: <br /> z) o r <br /> VCTw d <br /> S/ t¢.w // c <br /> 4. Description of equipment to be used: <br /> L4L <br /> C) <br /> gibes . — <br /> � -- -- ---- __ — roved. YES NO Ll <br /> 5. All equipment is State certified or app <br /> (5, Decontatnie+anon Procedures: <br /> nated prior to removal <br /> a. Will piping be decontami `? <br /> YES L] NOL] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> A// Phone(_) <br /> city Zip <br /> Address <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, <br /> Storage & Disposal Facility: <br /> Phone(__) <br /> Hauler Name <br /> 2 <br />