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RETROFIT OR REPAIR <br /> 1. Site map enclosed -YES [] NO [] <br /> forequipment to be installed YES [�'� NO [] <br /> 2. Spec sheets attached <br /> 3. Description of work to be completed: <br /> vi-Sil DeSI�P�C�'S +- rJYl Q <br /> 4. Description of equipment to be used: <br /> 0 0 V I Ad <br /> 0V\ elL-V-&t - <br /> 1 i _ <br /> If Cd p s,,7ePrS- <br /> 5. All equipment is State certified or approved. YES NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phone(__) <br /> Address City Zip <br /> C. Describe method to be used for decontamination: M <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> r <br /> Hauler NamPhoneL_) <br /> Nam,- _ <br /> 2 <br />