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RETROFIT -OR REPAIR <br />1- Site map enclosed YES j ] NO [] <br />2- Spec sheets attached for equipment to be installed YES (] NO ( ] <br />3. Description of work to be completed: <br />Cis L�•� + c �".�„ r��� <br />C\SPit <br />ocrnntion of eeu i_ nt t he used: <br />"� {l+L <br />5_ All equipment is State certified or approved_ YES [ j No[] <br />6_ Decontamination Procedures: <br />a_ Will piping be decontaminated priorto removal? YES <br />b_ Identify contractor performing decontamination_ <br />Name__ Phone( } <br />Address <br />-- CJS Zip —-V_ <br />c_ Describe method to be used for decontamination- <br />d- Describe how rinsate mater; Ai wr ii be stored on Ae p or tc maAifesting offsite_ <br />e. Rinsate.Hauler and permitted Treatment, Storage & Disposal Facility_ <br />Hauler flame Phone( <br />2 <br />