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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 completed: <br /> erg �uf Clel'� (n - <br /> 4. Decyrintinn r,f en��inment to he used: <br /> r <br /> M 51&b 2 b 363,►595 . <br /> 5_ All equipment is State certified or approved_ YESK NO (] <br /> 0. Decontamination Procedures: <br /> J. Will piping be decontaminated prior to removal? l <br /> Identify contractor peifommir:cf decoritaminabon- <br /> Name ----- -- PhoneL }---- --- --- <br /> Address City <br /> c_ Describe method to be used for decontamination: <br /> d. Describe he=v rinsate malterial will be stored onsite prior to manifesting offsite- <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal f=acility: <br /> Hauler Name Phone(__--} — <br />