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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 /> Og"fk-rM Cel-40VX-r <br /> ULJOI-p- <br /> anw,A) LF aA.,z Mo-r ewo <br /> T"C <br /> R P-S'a-a -MS-r.2r1&- or- 'UW— ftCC-&"'P"xx1A JF <br /> 4. Description of equipment to be used: <br /> LLd 45!gE F"..)CA-0sx-6 <br /> /S1jS-ML S*J5 <br /> 5. All equipment is State certified or approved. YES P( NO <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [] <br /> b. Identify contractor performing decontamination: <br /> t <br /> 0 removal? <br /> ova <br /> decontamination: <br /> 9 <br /> Name PhonZ <br /> Address ity Zip <br /> C. Describe method to be used for deco i tion: <br /> d. Describe how rinsate material * be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler an ermitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone( <br /> 2 <br />