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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 /> S. P§scdpt qn of work to be completed: <br /> led4 nc oaw --6-o wt !k Lte— S+ -EO C4 be. ire Q' <br /> a <br /> e+ <br /> ®' 1 M-" Vi...`7e"��Lim SV U-aV-e' ap Ll LM1Y �7 <br /> 4. Description of equipment to be used: <br /> 20&mem bw'Cl,- (Vichb(e e-v-cb-Qed)- <br /> 5. All equipment is State certified or approved. YES' NO [] <br /> 6. Decontamination Procedures, <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontaminatio <br /> Name Phone(L_ <br /> Address city Zip <br /> c. Describe method to be u d for decontamination: <br /> d. Describ7h ,4nsate material will be stored onsite prior to manifesting offsite: <br /> e. nsate Hauler and permitted Treatment, Storage& Disposal Facility: <br /> Hauler Name Phone( ) <br /> 2 <br />