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RETROFIT. OR REPAIR <br />1. Site map enclosed YES [] NO M <br />2. Spec sheets attached for equipment to be installed YES NO [ ] <br />3. Description of work to be completed: <br />2 E✓ c' C n_-�/� L r7 w i K C, l= G gn< C o *Q 6-vf-o rL i �( jam[ P� �c C, <br />PR4r>QC- r LtntC� <br />`) (Let Q CIL <br />4. Description of equipment to be used: <br />C L- y— o. -g It-t-T—o rL- -- L L )(I t M C-- <br />5. <br />5. All equipment is State certified or approved. YES pf NO [ ] <br />6. Decontamination Procedures: tq t 4, <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 />9 <br />