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07/11/2005 13; 29 9169277 44 CHMPION PT INC PAGE 04 <br /> 1P <br /> RETROFIT OR REPAIR <br /> 1. site map enclosed YES NO <br /> 2, Spec sheets attached for equipment to be installed YES [] NO <br /> 3. Description of work to be ComPletod: <br /> 4- Description of equipment to be used: <br /> AJI equipment is State Cerffied or approved, YF_S NO[] <br /> Decontamination Procedures: <br /> a. Will piping be dewntarninated prior to removal? YES[I NO [] <br /> b. Identify contractor performing decontamination'. <br /> Name Phone –, <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 oftite: <br /> e. Rinsate Hauler and perrnit Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(___j <br />