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Sep 26 2005 4: 29PM 7%rr g h t Env i ronmental 832-5152 -"Y1HL 1 r No , 1320 P 5i'6JL <br /> 0 <br /> RETRAFIT.OR REPAIR <br /> 1. Site map enclosed YES [, N0 � <br /> 2. Spec sheets attached for equipment to be installed YES H N® <br /> 3. Description of work to be completed: <br /> 4. Description of equipment to be u60d: <br /> 5. All equipment is State certified or approved• Y'ES Not) <br /> 6. tarnina on uC ®A A) 1 <br /> ��Jff YE5 [] NO () <br /> e. will piping be decontaminated prior to removal? <br /> b. identify contractor performing decontamination: <br /> Name Phone(_) <br /> Address <br /> CRY <br /> C. Describe method to be used for decontamination.- <br /> d, escri a how rine to material will be9Wr9d or sits prior to manifesting Oftsite.- <br /> Rjnsate Mauler end permitted Treatment, Storage &Disposal FacllitY: <br /> Hauler Name <br /> Phone(.r_} <br /> 2 <br />