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RETROFIT OR REPAIR <br /> 1 . Site map enclosed YES [) NO [] <br /> 2. Spec sheets attached for equipment to be in>talled YES [] NO [] <br /> 3. Description of work to be completed: <br /> tobors1 <br /> - n -Deyynntinn of c. .,vi anon ha used: <br /> r- _ <br /> i - <br /> WJJ <br /> GG J� --- .-- --- i <br /> i <br /> i <br /> 5- All equipment is State certified or approved_ YES [] NO f j <br /> 6. Decontamination Procedures: <br /> a_ Wilt piping be decontaminated priorto removal? ``E ! ) SC- <br /> b- Identify contractor performing decocitamination- <br /> Name - —_-- Phone(=_) <br /> Address— — — —City <br /> G_ Describe method to be used foi decontamination: <br /> d. Descrit)e how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate.Hauler and permitted Treatment, Storage& Disposal Facility_ <br /> Hauler Name PhoneL_ i' <br /> i <br /> 2 <br />