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11f V1! LVV1 VJ• JL <br />LV J"'FV VJ`TJJ <br />111 III 1 L -VVI♦ <br />RETROFIT OR REPAIR <br />1 "-IAL- UY <br />1. Site map enclosed YES [] NOI, <br />2. Spec sheets attached for equipment to be installed YES,-14"NO [ I <br />3. Description of work to be completed: <br />k c-INk i i , . i n 1 / 9 _ .?�� ; 1(a l� 1 I fir► `I-� <br />l ' ILL - <br />4. <br />L — <br />4. Description of equipment to be used: <br />e _ ( l <br />� 4 BT (&Z6 S U 14- <br />C) <br />5. All equipment is State certified or approved. YESX NO [I <br />6. Decontamination Procedures: Q <br />a. Will piping be decontaminated pri r 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 />2 <br />