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Feb 25 05 10: 56a Ca- ie Brown (200 ' 461 -6342 p. 1 <br /> RETROFIT QR REPAIR <br /> 11_ Site snap enclosed YES [] NO[J <br /> 2- Spec sheets attached for equipment to he installed YES [). NO [] <br /> 3_ Descri <br /> p <br /> t <br /> ion of work to be.completed; <br /> 'IMP, � 1`1l-rjl �l ���'?G� rl'y�'�' -11'�c`�� -.�nkf& <br /> 41.0i�� <br /> 4_ Description of equipment to be used: <br /> i <br /> 5- All,equipment is State cerh.'ied or approved, YES [] NO'[J <br /> 6- Decontamination Procedures_. . <br /> A- Will piping be decontaminated prior-to removai? YES (J NO [] <br /> b. Identify i:bntratMr performing deconta nination: <br /> Name <br /> Address _— City — Zip - <br /> C. Describe method'to be used for decontarnination: <br /> d. Des crk e hdW ririsate material i-ill'be stored onsite prior to manifesting offsite: <br /> e- Rinsate Hauler and permitted Treatment, Storage & Disposal Facility. <br /> Hauler Name _ Phone( <br /> 2 <br />