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Lft, RETROFIT OR REPAIR mw <br />1. Site map enclosed YES [I NO <br />2. Spec sheets attached for equipment to be installed YES)d NO [ ] <br />S. D�scdptign of work o be completed: <br />iec�n nc ave a wt Se v `ce. S -f A --EO t. S s ULS- tai ZQ bbe. 6usikQ a <br />Kjo 144 b VA -jZ e,,LjSfj �G U4 ottiL-ttayS 4v- &stfe i CUOJ - eC) P-lwkcc2em . <br />® •dam v` t a— �0ftu^^v Y t' <br />4. Description of equipment to be used: <br />33a ®dam - Y Mewi 66-y& Cvichre, ��C C0 <br />5. All equipment is State certified or approved. YES'g NO [ <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO [ j <br />b. identify contractor performing decontaminatia . <br />Name Phone( _) <br />Address _ City Zip <br />C. . Describe method to bXud r decontamination: <br />d. Describe ho msate material will be stored onsite prior to manifesting offsite: <br />e./.Hauler <br />ate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Name Phone{ <br />2 <br />