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RETROFIT OR REPAID <br />1. Site map enclosed YES [ ] NO K <br />2. Spec sheets attached for equipment to be installed YES [ ] NO <br />3. Description of work to be completed: <br />GN L A- c ir- <br />E—: c" A-' r c' C l 1 n(� <br />L E A'(G <br />►�/"K-c�t-v� <br />�j 2� � C. <br />A—►�. Vj VA L CAL i o t. 4-.L (, <br />Tc <br />4. Description of equipment to be used: <br />l EAy�Qo�-LEss LI Zcc0 1148-"A-*tac01-i Li�cr� <br />G AtL h�� Esc -0 2 - <br />5. All equipment is State certified or approved. YES 0 NO [] <br />6. 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 />