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RETROFIT OR REPAIR <br />1. Site reap enclosed YES ( ) NO [] <br />2. Spec sheets attached for equipment to be installed YES j) NO j ) <br />3. Description of work to be completed- <br />'iJrec��� <br />C) C_ G Co hob Q s <br />- Description of equipment to be used- <br />gar <br />sed- <br />r_-., - �. _ <br />1 aro s�fl <br />V 91 <br />yfl� C- L <br />IPEV <br />b- All, equipment is State certified or approved_ YES j l NO <br />. <br />S- Decontarrunation Procedures: <br />a_ Will piping be decontaminated priorto removal? YE`; j) No <br />b_ Identify contractor performir., t decontamination- <br />Name <br />Address <br />Cit}' <br />C_ Describe method to be used for decontamination: <br />d- Describe how rinsate material wilt be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted _' reat-nclnt, Storage & Dispos<t Fac:i(ity_ <br />Hauler Name <br />Phon <br />