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RETROFIT-OR REPAIR <br /> _ Site map enclosed YES(j NO(j <br /> 2- Spec sheets attached for equipment to be installed YES[]_ NO []- <br /> 3- <br /> O []3_ Description of work to be-completed_ <br /> ry)Cyt <br /> 3 It M/2 -61 ZVhQ QA ff <br /> a�-�0lt d;d <br /> 4- - Descriptbn of.equipment to be used. <br /> 5_ All.equipment is Sfate certd`ied or approved_ 'Y-ESI] NO(] _ <br /> 6- Decontamination Procedures.. . <br /> a- Will piping be decontaminated prior to removal? YES j] . NO[] <br /> -- b- tdentify_cori3ractor performing decontaimation - ;------ -- - . _ <br /> Name _ Phone( <br /> Address City Zip <br /> c- Describe method to be Used for decontamination_ <br /> d_ l�escriiie Eicrnl rtrisate material YMI�be stc,ed onsite Oat to rc�ai,ues rig_q site <br /> e- Rinsate Haider and permitted Treatment, Storage&Disposal_Facility_ . <br /> Hauler Name Phone( } <br /> 2 <br />