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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES NO[] <br /> 3. Description of work to be completed: <br /> aAacc LJ51 ,Spill canttincr5 for fillb► y.9 (Mast 1, with <br /> G•A. .ti3. -TitC ponents Mr executive, Order <br /> Vit- fo' -0. <br /> 4. Description of equipment to be used: <br /> Fhil-Tito, 501 wnt2inmeht bu4kcts, debris bodwt roixtslole aptor <br /> QrW elr®ptube,, norrison Bros. dual' aoM y pr•:sswy./v*e_UVM V"+ <br /> valve. end t�ivee's21 for � exf'rad'dr fitting• <br /> 5. All equipment is State certified or approved. YES NO[] <br /> 6. WA Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name e� Phone( ) <br /> Address City _Zip <br /> 2 <br />