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RETROFIT OR REPAIR <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: Lly1 <br /> We �Iro pose 10 re-AloVL -the e2<15 it q e lei rcolt. <br /> b4tJ SewSors 1N 411 4 4e UDCs X4 SompS , &Ao 1k3laIl mew Ueede✓'— <br /> P of �g43 D- 323 PC*ti lyh Seh317 ue. SeAJ()r5 . +/I rtew sewsors 40d <br /> - ►c �� dNn(;lkr S,-osor) cvd l he eer4 tltPd 6 be QcraV &Ad rldtq <br /> Ae atrect Avnw eAd 4-�Ju 1(4- <br /> U V <br /> 4. Description of equipment to be used: <br /> 64) 0-le 7g43W"323 ` PoSi�&A Sensrljye -C>aVjA' S'( (See A14c `e ` <br /> )_ <br /> 5. All equipment is State certified or approved. YES [l,]/ NO [I <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [�]� <br /> b. Identify contractor performing decontamination: <br /> Name N/A- 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 /> !U/t <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name N/,� Phone( ) <br /> 2 <br />