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06/17/2005 08:30 20946834lq EHD PAGE 04 <br />RETROFIT OR REPAIR <br />1. Site map enclosed YES NO [ 1 <br />2. Spec sheets attached for equipment to be installed YES/g NO [ l <br />3. Description of wo to be completed: U se C_G6Ua V <br />4. Description of equipment to be used: <br />OG <br />5. All equipment is State certified or approved. YES NO [ ] <br />6. Decontamination Procedures: e�It}. <br />a. Will piping be decontaminated prior to removal? YES[] NO(] <br />b. Identify contractor performing decontamination: <br />Name Phone(__j <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 <br />acilityHauler Name Phone(�� <br />VJ <br />tanm 4QQ_noul I onwa 1 "rias" V%fileae Friondlu fArYA" <br />