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RETROFIT_OR REPAIR <br /> 1. Site map enclosed YES [] NO Tf <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed: <br /> �1c. ce- `11 S7P - r-\ L43 1-ecl, k ac_c_Vvr <br /> 4. Description of equipment to be used: <br /> A <br /> Q- i P - �-n LQ r 0 C>90yc � <br /> r eelaC-CA K1414, S&wt C MWte A ye w <br /> b3 <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 /> Named Phone(�09 ) X16 I - (,3 3 <br /> Address City ip 9Q Ck ' <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 />