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0 RETROFIT OR REPAIR * <br />1. Site map enclosed YES vi/ NO [ ] <br />2. Spec sheets attached for equipment to be installed YES NO <br />3. Description of work to be completed: <br />"0/ <br />,Ve- LA/ 44,7e -'-2t. r <br />4. Description of equipment to be used: <br />Vdzrl-o2.45 A -14 -r -P <br />4A le, <br />5. All equipment is State certified or approved. YES [tK NO[] <br />6. Decontamination Procedures: AI�4 <br />a. Will piping be decontaminated prior to moval? <br />b. Identify contractor performing decontamination: <br />Name .. Phone{__1Z <br />=I- <br />C. Describe method to be used for d <br />Zip <br />[] NO[] <br />d. Describe how rinsate materiR4,ill be stored onsite prior to manifesting offsitei <br />e. Rinsate Havu4and permMed Treatment, Storage & Disposal Facility: <br />PhoneC__---) <br />