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' e <br />ISRETROFIT-OR REPAIR <br />1. Site map enclosed YES [ ] NO [I <br />2. Spec sheets attached for equipment to be installed YES [ ]. NO [ j <br />3. Description of work to be, completed: <br />4_ Description of equipment to be used: <br />5. 'All equipment is Statr: certified or approved. YES [ ] NO[] <br />6. Decontarninafion Procedures: <br />a. Will piping be decontaminated prioi, to removal? YES [] IGLU t ) <br />b. Identify contiact®r performing decontamination: -------.---_ <br />Name Phone(_=) <br />Address City Zip <br />C. Describe method to be used for decontamination: <br />d. Describe how rihsate material will be stored onsite prior to manifesting offsite_. <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Mauler Name Phone <br />2 <br />