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RETROFIT-OR REPAI* <br /> 1. Site map enclosed YES [ ] NO <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO g <br /> 3. Description of work to be completed: <br /> lZ E P L -GE- T I � Ct 1 a-•, I c A,-t l r &L E AV— <br /> F--TEc.--vo R- S `�, u 1Zt A-t' PJ V A L Q LT Q R mtc, C&M.'rc r(c A-riyq <br /> 4. Description of equipment to be used: <br /> Z E Pr ` / pr p o rL t E c s L b - Z O o o l:�tA A-•1i C N(. G Rc rZ <br /> L E A,� "�) G,7-F— -o r,- <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 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 />