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RETROFIT -OR REPAIR 10 <br />1. Site map enclosed YES [ ] NO [] <br />2. Spec sheets attached for equipment to be installed YES [I NO [] <br />3. Description of work to be completed: <br />— – C-2,'1 <br />is <br />4. , Description of equipment to be used: <br />3 <br />C` n f. Q r, g_-� e__ 1�o c- 3 u fA rn r o Y-. 2 D c_ <br />Y\ �S e C_ 0 Y\ A G,- r � V\ 1 Q c G G_ Y1 U <br />�)Q C x(1'1 u r <br />5. All equipment is State certified or approved. YES _rX NO [] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name t%No Phone Owl) `A 6 I 3� <br />Address city <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 />