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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [] NOK <br /> 2. Sec sheets attached for NO equipment to be installed YES <br /> P q P [] � <br /> 3. Description of work to be completed: <br /> 6 1�Q- � wlck -- Q� 11A i� <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YE06 NO [] <br /> 6n amination Procedures: <br /> a. piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify co actor performing decontamination: <br /> Name Phone( ) <br /> Address city Zip <br /> C. Describe method to be used for d ntamination: <br /> d. Describe how rinsate material will be stored onsite 'or to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility. <br /> Hauler Name Phone( ) <br /> 2 <br />