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RETROFITOR REPAIR <br /> 1 . Site map enclosed YES [] NO J4 <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO <br /> 3. Description of work to be completed: <br /> I ruSrt19LLEO M (E7 t"j Yyh t L - 2-000 <br /> L A K D t T:C--C-T-G 2 1 l�! `� I Tu 6 6 t " E 5 U M 13 <br /> 0 FR I LE At-( D E TE� T-0 I E' <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES NO [] <br /> 6. Decontamination Procedures: / <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phone_) <br /> Add ress 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 /> 2 <br />