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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 /> f�E�toVE �D�22. N010MA- T AJ S S'flc'�►t �JSTl4-!.� EE 2- �ooT <br /> M. <br /> 4. Description of equipment to be used: <br /> �EEO�. r 1 L3 350� CvnlsoLa P sen. t <br /> V"DeIL-Rwr M/44NETDaz5-rx1C'T1N(6 PRobes - I PER. TAN.- <br /> V - oT 1 M-rf R.STi-rl,*,1, Se wsv2S - I PF-4 TANK. <br /> rSump Sewsa" I -r K.. ANb I P <br /> 5. All equipment is State certified or approved. YESA NO [ ) <br /> 6. pjA 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 />