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C <br />1. Site map enclosed YES NO[] <br />11 <br />2. Spec sheets attached for equipment to be installed YESkq NO[] <br />3. Description of work to be completed: <br />Replace, UST 51AI <br />wntainerS <br />for fill & V.R. <br />f f1h2se 1, w;tln <br />G.A.K.15. gipprovej <br />M60 jife+ <br />l&nponen- 3 p®r <br />15xz 4tive. 01Jer <br />PLO] id 41QffAN <br />valve. -and LA-Ttiv&-sal Car aaor fift;nl. <br />5. All equipment is State certified or approved <br />6.WA Decontamination Procedures: <br />YES NO [] <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name Phone( ) <br />Address <br />F <br />YES[] NO[] <br />City __Zip <br />