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07/24/2006 12:59 4640138 EwiRoNvENTAL HEALTH PAGE 03 <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [} <br /> 2. Spec sheep attached for equipment to be installed YES [ ] <br /> 3. Description work to completed: ; C <br /> —� l d<j C <br /> j � f <br /> l <br /> i <br /> aR <br /> 4. Description of equipment to be <br /> r l -� <br /> 5. All equipment is State certified or approved. NO 11 <br /> 6. Decontamination PRrocedu <br /> a. Will gaping <br /> be decontaminated prier to remOval? YDS <br /> b. ldentify contractor peeorming d ntamination: <br /> Name Phone(,.—) <br /> Address <br /> City zip <br /> G. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stared onsite prior to manif sling Offsite: <br /> e Rinsate Hauler and permitted Treatment, Storage& Disposal Facility: <br /> Hauler Mame Phone�_____„_� <br /> 2 <br />