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1. Site map enclosed <br />2 <br />3. <br />El <br />I* RETROFIT OR REPAIS <br />YES tQ NO[] <br />Spec sheets attached for equipment to be installed YES (( NO [ ] <br />Description of work to be completed: <br />• EXC AVA,Tt;- AWc . EXTE-14o SrA4r.�F - WA -1-C VA -Po& 2CY-vaf4 PIP$4e, <br />I' --re 0 PK A R s A 9 E A-rZ K '3- T A -t4 K -r-0 9� 1P ( Pr tic <, 5: v ok p. <br />• �Xc A v,�-rE� <br />7EWO V L 9 40r{ i <br />E tj A-tiL)b <br />2EPIA-c& ft <br />TL k -VA <br />j Z (s 9 ,Z <br />-r-o c c 0 W r- 0 b a-rE <br />K F.W <br />E.A-c <br />Description of equipment to be used: <br />< 0& rr6v p:768 S rL CA -S -rjar P <br />EtilV(20O0 (J ti4F;✓7r-f2 krmrT 1 KCe- <br />'rE F0LcL iCOCX C 0 )z Ec-rOrL <br />P W F:7S A SE n -c A -D *PI Q - <br />All equipment is State certified or approved. YES M NO [ ] <br />Decontamination Procedures: <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 />A) <br />