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RETROFIT OR REPAIR <br />1- Site map enclosed YES [ ] NO [ j <br />2- Spec sheets attached for equipment to be installed YES[] <br />3. Description of work to be completed: <br />ILIO [I <br />/1_ ocr�nntinn of enitinrnonf in h�? stcPri <br />.. r- - <br />d ; <br />5_ All equipment is State certified or approved YES [ j NO [ j <br />C. Decontarn inaJon Proced{ares= <br />a_ Will piping be decontaminated priorto removai7 YDS [ j NO I <br />b_ identify contractor performing decontamination_ <br />Mame_ Phone f ? <br />Address <br />Cit} Zip <br />C_ Describe method to be used for decontamination - <br />Describe _hQ.w rinsate material viii be stored onsite prior to manifesting offsite-- <br />e. <br />ffsite` <br />e. Rinsate.Hauler and permitted Treatment, Storage & Disposal Facility-- <br />Hauler <br />acility-Hauler [dame Phone -L-}- <br />