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RETROFIT-OR REPAIR <br /> 1- Site map enclosed YES f] NO [] <br /> 2. Spec sheets attached for equipment to be installed YES NO <br /> t] <br /> 3. Description of work to be completed: <br /> V / ;;11 <br /> ,5 c� <br /> _ ? D?s'.n�firVrn of equiDmenf to be used: <br /> 7a d _- w,,r Its <br /> 5- All equipment is State certified or approved- YES [] NO f] <br /> Decontamination Procedures- <br /> 5. W41 piping he deconfaminat ,d priurte i-emova!'% <br /> YES <br /> . Identify contractor pe;corm �y de+ on;asr�irtatio� <br /> Phcne <br /> Address <br /> z'p- <br /> c. Desc-nbe method to be used for decontamination; <br /> d. Describe how nnsate material will be stored onsiteriot to manifesting <br /> p g <br /> e. Rinsate Hauler and permitted Treatment, Storage$ Disposal Facility- <br /> Hauler Name _Ph�.ne{-�� <br /> 2 <br />