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RETROFIT-OR REPAIR <br /> 1- Site map enclosed YES () NO j j <br /> 2. Spec sheets attached for equipment to be installed YES [] NO () <br /> 3- Description of work to be completed: <br /> 1 e dei- e yr on $"1 oc�" <br /> .)eSCrintinn nf ens simm�nt fn h? used: <br /> - <br /> r--� - <br /> 1.eal6, A cA-e- c_1-o C' � <br /> 5- Al; equipment is State certified or approved- YES j J NO <br /> 6- Decontamination Procedures: <br /> a. Will piping be decontaminatedriorto removal? <br /> P YES j) NO i <br /> b_ Identify contractor performing decontamination_ <br /> Name Phone( ) <br /> Address <br /> City Zip <br /> C_ Describe method to be used for decontamination- <br /> escnbe how nrisate mateitd will be.stared onsite-p6or to manifesting <br /> r <br /> i <br /> e. Rinsate.Hauler and permitted Treatment,Storage& Disposal Facility- <br /> Hauler <br /> acilityHauler Name Phone___ i <br /> i <br /> I <br /> � — s <br />