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•R� <br />RETRORIOR REPAI <br />1. Site map enclosed YES`] NO [] <br />2. Spec sheets attached for equipment to be installed YES)U- <br />3. Description of work to be completed: <br />NO [] <br />4. Descripfion of equipment to be used: <br />X, - y ,CSG p �U ,'0 <br />� �' <br />-[] <br />5. All equipment is State certified or approved. YEA NO <br />6. Decontamination Procedures: <br />a Will piping be decontaminated prior to removal? <br />YES[] No[ ] <br />b. Identify contractor performing decontaminator: -- . <br />Name PhoneL_) <br />Address City Zip - <br />C. Describe method to be used for decontamination: <br />ate ma�erial will be stored onsite prior to mantfest <br />d. Describe :pow rinsmg <br />offsite:. <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />- Phoneme_) <br />2 <br />